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lesion
Papules/wheals; circumscribed Lightly erythematous > > central clearing/blanched blanched with pressure
swelling
location
sensation
pruritus
PATHOPHYSIOLOGY
CLASSIFICATION
I.
CLASSIFICATION
II. Ethiology & pathophysiologic mechanism A. Immunologic Hypersensitive reaction B. Anaphylactoic 1. Hereditary Angioedema 2. Histamine liberators 3. Aspirin
CLASSIFICATION
C. Physical: 1. Dermatographia ("writing on the skin") 2. Cold urticaria 3. Cholinergic urticaria 4. Heat urticaria 5. Solar urticaria 6. Pressure urticaria & angioedema 7. Vibratory angioedema 8. Aquagenic urticaria
CLASSIFICATION
D. Miscellaneous 1. Papular urticaria 2. Urticaria pigmentosa 3. Systemic mastocytosis 4. Infection + urticaria 5. Urticaria with underlying systemic disease a. Collagen vascular diseases b. Malignancies c. Endocrine hormone imbalance 6. Psychogenic factors 7. Idiopathics urticaria & angioedema
HYPERSENSITIVITY
TYPE I
Ig-E mediated mediator release E/ : fish, berries, nut, egg, chocolate, drugs, bee-sting, animal danders/saliva Ig-E passive transfer -----> Prausnitz-Kustner rct D/ : avoidance-challenge test skin prich / scratch / intradermal test serum Ig-E total/specific Eosinophyl count
TYPE II
Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen
Complement activation
TYPE III
Serum sickness : urticaria, arthralgia, fever
PATHOPHYSIOLOGY
HEREDITARY ANGIOEDEMA
1
2
Relative frequency
Precipitant
3 4
5
Onset Duration
Symptomes a. local b. systemic
2 - 4 days
recurrent, angioedema, urticaria (-), non pruritic headeache, recurrent abdominal pain, laryngeal edema,
Tests
C2 C2
7
8
Mechanism
Treatment
PHYSICAL URTICARIA
Dermo / Dermato Graphism Writing on the skin
1 Relative frequency Most frequent
2
3 4
Precipitant
Onset Duration
Stroking skin
immediate minutes delayed: 3-8 hours immediate: 2-3 hours delayed: 24-48 hours
Symptomes a. local
b. systemic
immediate: erythema, wheal, pruritus +/delayed: erythema, wheal, pruritus +/-, nodule none
6
7 8
Tests
Mechanism Treatment
scratch skin
immediate: histamine delayed: ? antihistamine continuous 1st + 2nd generation
COLD URTICARIA/ANGIOEDEMA
Familial Idiopathic more common
cold few minutes 1-2 hours
1
2 3 4 5
rare
b. systemic
Tests
erythematous immediate: papules, nonpruritic, burning delayed: deep swelling Fever, arthralgias, chills, headache, myalgias, lekositosis apply cold material on skin (-)
urticaria/angioedema
urticaria/angioedema
~ underlying disease
Mechanism
Treatment
autosomal dominant passive transfer IgE (IgM) in heritance histamine delayed: ? precipitant avoidance antihistamine desensitization
Heat
1
2 3 4 5
Solar
uncommon
various wave - length (light) 1 - 5 minutes 15 minutes - 3 hours
Pressure
frequent
pressure 3 - 12 hours 8 - 48 hours
rare
heat 2 - 5 minutes rarely: few hours 1 hours
pruritic wheals -
b. systemic
Tests
Mechanism
Treatment
pruritic morbiliform erytheme wheal wheezing dizziness syncope light exposure --> variable wave length copro porphyrine passive transfer Ig-E Histamine? avoidance antihistamine sunscreen
red deep swelling tender fever, chills arthralgia ESR, lekositosis apply weight ( 7 - 14 kg); 10 minutes
?
V Ib r a t o r y
1
2 3 4
Aq u a g e n Ic
rare
water contact several - 30 minutes 30 - 45 minutes
Relative frequency
Precipitant Onset Duration
very rare
vibration 2 - 5 minutes 1 hours
Symptomes a. local
b. systemic
6 7
8
Tests Mechanism
Treatment
MISCELLANEOUS
Papular
- E/: insects bite e.q. mosquito, bug, flea - biphasic pruritus, papular wheal - Hsr - type I & IV - T/: antihistamine
MISCELLANEOUS
MISCELLANEOUS
Systemic mastocytosis
- more serious and rare - flushing, headeache, hypotension - mast cells accumulation: dermis, B.M., GIT
DIAGNOSTIC APPROACH
1. General History : a. Foods / inhaled aromas b. drugs c. food additives d. inhalants, contactant : dust, pollen, pet e. occupation, hobbies f. recent infection
physical examination
suspect cause
2. Specific
TREATMENT
A. General 1. Elimination : identified Cause unidentified avoid : histamine releasing agents peripheral circulation 2. Antihistamine d.o.c 3. Adrenergic Life threatening s.c. inj. epinephrine : 1 / 1000 ; 0,01 ml/kg B.W. maximal 0,2 - 0,3 ml table remove
pruritus
TREATMENT
calamin lotion
TERIMA
KASI H