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URTICARIA
 Commonly referred to as hives, is a kind
of skin rash notable for pale red, raised,
itchy bumps. Hives are frequently caused
by allergic reactions
Urticaria - Causes
The majority of chronic hives cases have
an unknown (idiopathic).
Acute viral infection is another common
cause of acute urticaria (viral exanthem)
Less common causes of hives include
friction, pressure, temperature extremes,
exercise, and sunlight.
APPEARANCE OF
SYMPTOMS
Wheals (raised areas surrounded
by a red base) from urticaria can
appear anywhere on the surface of
the skin.
Wheals may be pinpoint in size, or
several inches in diameter.
Fluid leakage from superficial
blood vessels
Immunologic Mechanism:
(A) Type I -HYPERSENSITIVITY REACTION.
(B) Type III- HYPERSENSITIVITY REACTION.
Non Immunologic Mechanism
(a) direct effect
(b) effect on archidonic acid metabolism-
Leukotrien B4
(C) idiopathic or undetermined
CLASSIFICATION
1.Acute Urticaria.
Presence of evanescent wheals which completely
resolve within six weeks.
2.Chronic urticaria (ordinary urticaria)
Presence of evanescent wheals which persist
for greater than six weeks.
Food item: Spicy food, Egg, Fish, Strawberry even milk
and it product.
Drug: Aspirin, Certain Antibiotics, NSAID. ,Codeine ,
Morphine.
Inhalants :- Pollen - Spore – House Dust Mite.
INFECTION AND INFESTATION:
 Psychological factor play important role
Certain systemic diseases : Malignancy [lymphoma ]
endocrine.
Diseases as [thyrotoxicosis . polycythemia] , Liver
Disease, Pregnancy
Drug-induced urticaria
Urticaria by infection or
environmental agent
Dermatographic urticaria
Pressure or delayed pressure
Classification By Cause
Classification …
 Chronic cold urticaria
 Solar urticaria
 Water-induced urticaria
 Exercise urticaria
 General : CBP , ESR, GSE, GUE, urine and blood
sugar, liver and renal function tests.
 Skin test: commonly used in patient with chronic
urticaria.
 Certain disease commonly associated with chronic
urticaria as sinus infection, UTI, hyperthyroidism,
intestinal warms, internal malignancy, lymphoma,
pregnancy and chronic exposure to external allergen.
It can be difficult to determine appropriate
medications, since some, such as loratadine, require a
day or two to build up to effective levels, and the
condition is intermittent and outbreaks typically clear up
without any treatment.
Treatment plans for urticaria involve being aware of
one's triggers
Antihistamines such as diphenhydramine may be
used.
MANAGEMENT
 85/15 ratio of skin H1/H2 receptors
 Combination of anti H1&2 provides
additional treatment benefit
 Doxepin blocks both receptors and
is a more potent anti-H1 blocker than
diphenhydramine or hydroxizine
 Sedation may limit usefulness of
doxepin
 Zafirlukast and montelukast superior to placebo
in treatment of chronic urticaria.
 Have not been compared to therapy with
antihistamines.
 No additional effect once maximal antihistamine
effect achieved.
 Oral sympathomimetics (e.g., terbutaline) studied to reduce
erythema / swelling
 Side effects substantial (insomnia, tachycardia)
 Efficacy low
SYMPATHOMIMETIC
AGENTS
 Indicated when inadequate response to
histamine receptor blockers and leukotriene
receptor antagonists
 Effective but with substantial side effects
 Alternate day therapy if must be used
 One approach – start 15-20 mg qod and taper
to 2.5-5mg q three weeks, d/c after 4-5 months
Experimental
Therapies
 Cyclosporine at low doses (2.5-3 mg/kg) effective and
steroid sparing
 High dose (6 mg/kg) very effective but with severe side
effects
 Other agents less well studied include sulfasalazine,
hydroxychloroquine and dapsone, IV IgG
 Plasmapheresis for patients with anti-IgE Ab effective but
impractical for long-term treatment
Recommendations
 Laboratory workup rarely necessary (except thyroid
evaluation)
Antihistamines mainstay of therapy (H1and H2)
Nonsedating at low/high doses effective for mild/moderate
disease
Older, sedating antihistamines more effective for severe
urticaria and/or angioedema
Minimize systemic corticosteroids (alternate day)
Contact Dermatitis
It is a term for a skin reaction (dermatitis) resulting
from exposure to allergens (allergic contact dermatitis)
or irritants (irritant contact dermatitis).
Phototoxic dermatitis occurs when the allergen or
irritant is activated by sunlight.
Symptoms
 Localized rash or irritation of the skin caused by contact
with a foreign substance.
Only the superficial regions of the skin are affected in
contact dermatitis.
Contact dermatitis results in large, burning, and itchy rashes,
and these can take anywhere from several days to weeks to
heal.
Causes
The most common causes of allergic contact
dermatitis a
The alkyl resorcinols in Grevillea banksii and
Grevillea 'Robyn Gordon' are responsible for
contact dermatitis re plants of the
Toxicodendron genus.
Other common causes of irritant contact
dermatitis are harsh (highly alkaline) soaps,
detergents, and cleaning products.
Classification
Irritant contact dermatitis
Allergic contact dermatitis
Photocontact dermatitis
Self-care at home.
Immediately after exposure to a known allergen or irritant,
wash with soap and cool water to remove or inactivate
most of the offending substance.
Medical care
Corticosteroids.
Antihistamines.

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URTICARIA AND CONTACT DERMATITS-MEDICAL-BIOMEDICAL-MATHANKUMAR S

  • 1.
  • 2. URTICARIA  Commonly referred to as hives, is a kind of skin rash notable for pale red, raised, itchy bumps. Hives are frequently caused by allergic reactions
  • 3. Urticaria - Causes The majority of chronic hives cases have an unknown (idiopathic). Acute viral infection is another common cause of acute urticaria (viral exanthem) Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight.
  • 4. APPEARANCE OF SYMPTOMS Wheals (raised areas surrounded by a red base) from urticaria can appear anywhere on the surface of the skin. Wheals may be pinpoint in size, or several inches in diameter. Fluid leakage from superficial blood vessels
  • 5. Immunologic Mechanism: (A) Type I -HYPERSENSITIVITY REACTION. (B) Type III- HYPERSENSITIVITY REACTION. Non Immunologic Mechanism (a) direct effect (b) effect on archidonic acid metabolism- Leukotrien B4 (C) idiopathic or undetermined
  • 6. CLASSIFICATION 1.Acute Urticaria. Presence of evanescent wheals which completely resolve within six weeks. 2.Chronic urticaria (ordinary urticaria) Presence of evanescent wheals which persist for greater than six weeks.
  • 7. Food item: Spicy food, Egg, Fish, Strawberry even milk and it product. Drug: Aspirin, Certain Antibiotics, NSAID. ,Codeine , Morphine. Inhalants :- Pollen - Spore – House Dust Mite. INFECTION AND INFESTATION:  Psychological factor play important role Certain systemic diseases : Malignancy [lymphoma ] endocrine. Diseases as [thyrotoxicosis . polycythemia] , Liver Disease, Pregnancy
  • 8. Drug-induced urticaria Urticaria by infection or environmental agent Dermatographic urticaria Pressure or delayed pressure Classification By Cause
  • 9. Classification …  Chronic cold urticaria  Solar urticaria  Water-induced urticaria  Exercise urticaria
  • 10.  General : CBP , ESR, GSE, GUE, urine and blood sugar, liver and renal function tests.  Skin test: commonly used in patient with chronic urticaria.  Certain disease commonly associated with chronic urticaria as sinus infection, UTI, hyperthyroidism, intestinal warms, internal malignancy, lymphoma, pregnancy and chronic exposure to external allergen.
  • 11. It can be difficult to determine appropriate medications, since some, such as loratadine, require a day or two to build up to effective levels, and the condition is intermittent and outbreaks typically clear up without any treatment. Treatment plans for urticaria involve being aware of one's triggers Antihistamines such as diphenhydramine may be used. MANAGEMENT
  • 12.  85/15 ratio of skin H1/H2 receptors  Combination of anti H1&2 provides additional treatment benefit  Doxepin blocks both receptors and is a more potent anti-H1 blocker than diphenhydramine or hydroxizine  Sedation may limit usefulness of doxepin
  • 13.  Zafirlukast and montelukast superior to placebo in treatment of chronic urticaria.  Have not been compared to therapy with antihistamines.  No additional effect once maximal antihistamine effect achieved.
  • 14.  Oral sympathomimetics (e.g., terbutaline) studied to reduce erythema / swelling  Side effects substantial (insomnia, tachycardia)  Efficacy low SYMPATHOMIMETIC AGENTS
  • 15.  Indicated when inadequate response to histamine receptor blockers and leukotriene receptor antagonists  Effective but with substantial side effects  Alternate day therapy if must be used  One approach – start 15-20 mg qod and taper to 2.5-5mg q three weeks, d/c after 4-5 months
  • 16. Experimental Therapies  Cyclosporine at low doses (2.5-3 mg/kg) effective and steroid sparing  High dose (6 mg/kg) very effective but with severe side effects  Other agents less well studied include sulfasalazine, hydroxychloroquine and dapsone, IV IgG  Plasmapheresis for patients with anti-IgE Ab effective but impractical for long-term treatment
  • 17. Recommendations  Laboratory workup rarely necessary (except thyroid evaluation) Antihistamines mainstay of therapy (H1and H2) Nonsedating at low/high doses effective for mild/moderate disease Older, sedating antihistamines more effective for severe urticaria and/or angioedema Minimize systemic corticosteroids (alternate day)
  • 18. Contact Dermatitis It is a term for a skin reaction (dermatitis) resulting from exposure to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight.
  • 19. Symptoms  Localized rash or irritation of the skin caused by contact with a foreign substance. Only the superficial regions of the skin are affected in contact dermatitis. Contact dermatitis results in large, burning, and itchy rashes, and these can take anywhere from several days to weeks to heal.
  • 20. Causes The most common causes of allergic contact dermatitis a The alkyl resorcinols in Grevillea banksii and Grevillea 'Robyn Gordon' are responsible for contact dermatitis re plants of the Toxicodendron genus. Other common causes of irritant contact dermatitis are harsh (highly alkaline) soaps, detergents, and cleaning products.
  • 21. Classification Irritant contact dermatitis Allergic contact dermatitis Photocontact dermatitis
  • 22. Self-care at home. Immediately after exposure to a known allergen or irritant, wash with soap and cool water to remove or inactivate most of the offending substance. Medical care Corticosteroids. Antihistamines.