Dermatology Al Azhar University Gaza urticaria and angeoedema

1. Urticaria and angeoedema
By
Shatha al sulh

2. • a group of disorders characterized by the formation of weals
• Nettle rash
• Dermal oedema
• Histamine
• autoimmune aetiology: lymphocytes

3. Clinical features:
• The skin itches or stings
• Weals develop
• always clear spontaneously within a few hours, even though new
lesions may continue to develop.
• angioedema :especially around the eyes and lips and in the mouth
and pharynx
• may form part of a systemic anaphylactic reaction.

4. Clinical forms:
• Acute urticaria:
• Attacks last only a few hours or days
• Contact, ingestion (food, drug), infection.
• Mast cell degranulation (IgE, direct)
• Atopy > susceptible
• Chronic urticaria:
• > 6w
• a single causative factor is rarely found
• caused by an autoimmune process or one of the physical stimuli

5. wheals
angioedema

6. • The physical urticarias
• Dermographism
• Pressure (delayed)
• Cholinergic urticaria: small white weals with a red halo on the upper trunk.
• Cold: contact with cold objects or blasts of cold air
• Water.
• Sunlight.
• Heat
• Chronic spontaneous/idiopathic urticaria : is diagnosed when no
other trigger can be identified
• Hereditary angioedema:
• very rare AD
• C1 esterase inhibitor is lacking or defective.
• sudden attacks of angioedema, which can be life‐threatening.
• The gut (spasms of abdominal pain).

7. Dermographism

8. Treatment of urticaria:
• If a possible trigger can be elicited from the history, it should be avoided.
• Aspirin and aspirin‐like substances should be avoided by anyone prone to
urticaria
• H1‐receptor antihistamines: sedating and non sedating effect (e.g.
desloratadine, levocetirizine, fexofenadine).
• H2‐receptor antagonist (cimetidine, ranitidine
• other agents: such as montelukast, systemic steroids, ciclosporin, and
adrenaline
• biologic agent omalizumab (anti-IgE)
• Angioedema: may require parenteral therapy with adrenaline,
antihistamines and steroids.
• Anaphylaxis: adrenaline is required.
• Hereditary angioedema: Danazol , Purified enzyme preparations

9. Erythema multiforme

10. • Aetiology: idiopathic, HSV,orf, hepatitis, mumps.
Mycoplasma, Cancers, radiotherapy, Connective tissue
diseases, drugs
• Examination:
• The classic lesion is the ‘iris’ or ‘target’ lesion
• about 3 weeks.
• Extensor surfaces of the arms and legs.
• Mucous membranes
• palms and soles
• Skin lesions may blister (bullous erythema multiforme).
• Treatment: self‐limiting, and treatment is not usually required.

11. Target lesions of erythema multiforme Erosions on the lips in erythema multiforme

12. Stevens–Johnson syndrome

13. • major systemic disturbance
• acute onset
• severe inflammation of conjunctivae, mouth and
genitalia
• Patients occasionally die of severe bronchopulmonary
involvement or renal
• failure.
• Treatment:
• fluid balance and nutrition
• role of systemic steroids is controversial

14. Stevens–Johnson syndrome

15. Stevens–Johnson syndrome

16. Erythroderma (exfoliative dermatitis)

17. •most of the skin becomes red, inflamed and oedematous
•There may be some scaling.
•four most important causes:
• Psoriasis.
• Eczema/dermatitis.
• Drug reactions.
• Lymphomas (especially cutaneous T‐cell lymphoma).
•management depends on the underlying disease process

18. Erythroderma