This document summarizes different types of urticaria (hives), angioedema, drug eruptions, and erythema multiforme. It describes the characteristics of acute and chronic urticaria, physical urticaria, urticarial vasculitis, and contact urticaria. It also discusses erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum, fixed drug eruptions, exanthematous drug eruptions, and drug hypersensitivity syndrome. Treatment options are provided for many of these conditions.

1. URTICARIA, EM &
DRUG ERUPTIONS

4. URTICARIA
• WHEALS
---------- transient <24hrs
superficial,
well demarcated
--------- erythematous/pale swellings of dermis
with itching

6. ANGIOEDEMA / QUINCKE’S
EDEMA
-poorly defined -affects deeper
dermal,s/c,submucosal
-pale/normal colour -usually last longer
-painful

7. CLASSIFICATION
• BASED ON DURATION
A/C ,C/C , episodic

8. CLASSIFICATION
• BASED ON CLINICAL PICTURE
-ordinary-a/c ,c/c
-physical&cholinergic -urticarial vasculitis
-contact urticaria -angioedema
without wheals

9. ACUTE URTICARIA
• CAUSES -IDIOPATHIC
-ALLERGIC
drug(penicillin), food(eg.shellfish), sting(eg.bee)
-NON ALLERGIC histamine
liberators -vanco pseudo allergic-
NSAIDS, pineapple -
INFECTION

10. CHRONIC URTICARIA
• PROVOKING/AGGRAVATING FACTORS -
drugs -food & food
additives -infection /
infestation -inhalants
-systemic d/s -implants
-menstrual cycle & pregnancy -stress

11. AUTOIMMUNE URTICARIA
• Due autoantibodies against FC€R1 receptors or to IgE bound
to the same receptor
• Lead to cross linking of 2 adjacent FC€R1 receptors and mast
cell degranulation

13. PHYSICAL URTICARIA
• DERMOGRAPHISM
• DELAYED PRESSURE URTICARIA
• CHOLINERGIC URTICARIA
• COLD URTICARIA
• SOLAR URTICARIA
• AQUAGENIC URTICARIA

14. URTICARIAL VASCULITIS
• >24-48hrs
• Burn/itch
• Tender/painful
• Residual bruising / staining
• Pupuric spots / rarely bullae
• Constitutional sympyoms

15. CONTACT URTICARIA
• ALLERGIC allergen
penetrate (eg.oral allergy syn)
• NON ALLERGIC by
direct injection of vasoactive chemicals by plants(eg.nettles)
or animals(eg.caterpillars)

16. Treatment of urticaria
• Antihistamines-H1 ,H2
• Steroids -a/c exacerbation
-UV -severe DPU
• Epinephrine-AE
• Plasmapheresis,IVIg, cyclosporine

17. HEREDITARY ANGIOEDEMA
• AD
• C1 esterase inhibitor deficiency
• Type1,2,3
• C4 screening, C1 esterase functional assay
• Rx-attenuated androgens,FFP, partly purified prep.n

18. ERYTHEMA MULTIFORME
• young age
• Mainly by infecton & drugs
• MCC- herpes simplex infection
• Extremities & face
• Mucosa may be involved
• Subsides in few weeks
• Typical lesion- target lesion

22. Target / iris lesion
• 3 ZONES
CENTRAL- dusky violaceous
erythema/blister/necrosis
MIDDLE- pale edematous
OUTER-erythema

23. treatment
• Symptomatic
• Systemic steroids if severe
• Acyclovir if recurrent

24. SJS TEN SPECTRUM
• SJS BSA<10%, 2 or
mucosa involved
• SJS-TEN OVERLAP BSA 10-
30%
• TEN BSA>30%

25. Drugs causing
• SHORT TERM -
penicillin,sulpha,quinolones,
cephalosporin ,p.mol
LONG TERM
-anticonvulsants,ATT,ART, allopurinol

28. SJS
• Sudden onset
• Prodrome
• Skin- erosions/blisters OR
EM like lesions
• Mucosa –oral(100%), eye(91%), genital(57%)

31. TEN
• SKIN -poorly
defined macules with purpuric/blistering centres
-EM like maculopapular rash
-confluent erythema -blisters over
palms&soles
• Extensive mucosal lesions
• Nikolsky +ve

32. Immediate Rx
• Withdrawal of offending drug
• Fluid replacement
• Nutritional support
• Dressing
• Temp regulation
• Corticosteroids,IVIg, cyclosporine

33. Continuing management
• Ophthalmic / oral care
• Antibiotics
• Monitoring of complications
• Prevention of recurrences

34. Prognosis-SCORTEN index
-age>40 -HR>120
-BUN>28mg/dl -RBS>252mg/dl
-HCO3- <20mg/ml
-initial BSA>30%
-presence of malignancy
1-3.2% 5or>5-90%

36. FDE
• Recurs at same site
• After 30mts-8hr
• Round/oval, sharply demarcated,itchy lesion
• Erythema&edema…..dusky violaceous
brown…..crusting&scaling………….post inflammatory
hyperpigmentation

38. • Limbs,hands&feet
• Oral,anal&genital
• Repeated attacks-new lesions,lesions increase in size
• Cotrimoxazole,tetracycline, NSAIDS

40. EXANTHEMATIC DRUG
ERUPTION
• Most common
• Upto 3 weeks
• Erosive stomatitis
• Face&pressure areas spared
• Intertriginous areas favoured
• Palmar&plantar lesions
• Purpuric lesions
• Penicillin,sulpha,NSAIDS, anticonvulsant

41. DHS
• DRESS / DIDMOHS
• After 3-6 weeks
• Facial edema with infiltrated papules
• Exnthematous rash …..exfoliative dermatitis
• Hepatitis,nephritis,pneumonitis,myocarditis

42. • Hypereosinophilia&atypical lymphocytes
• LNE
• DRUGS-anticonvulsants,sulpha, dapsone,minocycline,
terbinafine
• Rx- steroids

43. Drug induced pseudolymphoma
syndrome
• More insidious onset – usually after 7 weeks
• Facial edema+ but no fever
• Ery. plaques / multiple infiltrative papules
/ solitary nodule
• Rx- drug withdrawal
• Anticonvulsants,antipsychotics,antihistamines,CCB,ACEI,beta blocker

44. AGEP
• Multiple pustules with fever mimicking pustular psoriasis
• within 24 hrs
• Start on face& flexures
• penicillin / macrolide