The following is a precise description about urticaria & angioedema from dermatology

1. URTICARIA & ANGIOEDEMA
MUHAMMED JASIL

2. Urticaria: irregularly shaped wheal with a
blanched center surrounded by a red flare
Itchy raised rash
Rapid disappearance to normal skin in 1-24
WHEALS:
1)Evanescent
2)Edematous plaque
3)Central pallor, peripheral erythema

6. URTICARIA
CHRONIC
SPONTANEOUS INDUCIBLE
ACUTE

8. ETIOLOGY
ACUTE:
DRUGS: b lactam antibiotics,
sulfonamides, aspirin
FOOD: milk, egg, peanut, fish, wheat
INFECTIONS
INSECT BITES & STING
CONTACTANTS & INHALANTS

9. CHRONIC:
PHYSICAL FACTORS: cold, heat,
dermatographic, pressure, solar
IDIOPATHIC
AUTOIMMUNE
VASCULITIC
INFECTIOUS

10. INFECTIONS
VIRAL: HS, Hep B
BACTERIAL:
PARASITIC: Ascaris, fasciola, filarial,
Schistosoma
FUNGAL: Candida

11. PHYSICAL URTICARIA:PRESSURE
Large, painful or itchy red swellings @
sites of pressure(soles, palm or waist)
Lasting 24 hrs or more
Application of pressure perpendicular to
the skin produces red swelling after 1-4
hrs

12. DERMOGRAPHICURTICARIA
Itchy, linear wheals with surrounding
bright red flare @ sites of scratching or
rubbing
Most frequent form of physical urticaria
Affecting mainly young adults

13. PHYSICAL URTICARIA:COLD
Erythematous edematous deep swellings @ the
sites of contact with cold surfaces or fluids (9-
18hrs after)
Acquired & inherited forms
Acquired 1º & 2º
1º- idiopathic
2º-circulating cryoglobulins, cryofibrinogens,
cold agglutinins & cold hemolysins
Inherited-autosomal dominant, erythematous
macules & infrequent wheals

15. PHYSICAL URTICARIA:LOCAL HEAT
A rare form of urticarial
Induced by direct contact of the skin
with warm objects or warm air
38°C-50ºC

16. PHYSICAL URTICARIA:SOLAR
Develop within minutes after exposure to
sun
Usually idiopathic
May be associated with SLE, Polymorphic
light eruption

17. VIBRATORY URTICARIA
After several yrs of occupational exp to
vibration
Autosomal dominant
Assc with cholinergic urticaria
Typical symptom is hives across the back
when towelling off after a shower

18. PHYSICAL URTICARIA:CHOLINERGIC
Itchy, monomorphic pale or pink wheals
on the trunk, neck & limbs after exercise
or a hot shower
Anything that rises the internal body
temperature

19. ADRENERGICURTICARIA
Wheals surrounded by a white halo
Develop during emotional stress
Elicited using the IC inj of NE

20. CONTACTURTICARIA
Direct contact with a variety of
substances
IgE mediated or non immunologic
Proteins from latex : MC cause of IgE
mediated

21. AQUAGENIC URTICARIA
Pruritus alone or more rarely urticaria
Water of any temp
Reminiscent of cholinergic urticaria

22. DIAGNOSIS
Thorough history
Physical examination
Routine diagnostic tests
Autologous serum skin test
Basophil histamine release assay

26. Rx:
Identification & elimination of
underlying cause or trigger
Symptomatic pharmacological treatment
Induction of tolerance

29. DD-URTICARIA
 URTICARIA PIGMENTOSA
 URTICARIA VASCULITIS
 ERYTHEMA MULTIFORME
 IMMUNOBULLOUS
DISEASE-BP
 COLLAGEN VASCULAR
DISEASE
 ANNULAR ERYTHEMA
 JUVENILE RHEMATOID
ARTHRITIS
 KAWASAKI DISEASE
 VIRAL EXANTHEMS
 SCABIES

34. Angioedema: vascular reaction involving the
deep dermis, sub cutaneous or sub mucosal
tissues caused by dilatation & increased
permeability of capillaries
Sites: eyelids, lips, tongue, genitalia, hands,
feet & larynx
Gi & urinary bladder being less commonly
involved
pain> itchy
Recover slowly (72hrs)

36. TYPES
HEREDITARY
ACQUIRED

37. Rx
No regular medication needed in many
caese
Prophylactic stanozolol or danozolol
Fresh frozen plasma before emergency
surgery
C1 inhibitor
Symptomatic treatment during attacks

39. DD-ANGIOEDEMA
 CHF
 LYMPHEDEMA
 THROMBOPHLEBITIS
 ERYSIPELAS
 CELLULITIS
 NEPHROTIC SYNDROME
 SVC SYNDROME
 SCLERODERMA
 DERMATOMYOSITIS
 CROHN’S DISEASE