Post on 18-Nov-2014
The first affiliated hospital of zhengzhou univerThe first affiliated hospital of zhengzhou universitysity
subject Dermatology and venerology grade Oversea student
Dept. of DermatologThe First Affiliated Hospital of Zhengzhou University
Teaching way multimedia class hour 2
content Urticaria
Objective To master the clinical features, diagnosis and treatment of urticaria and angioedema
Key coceptAngioedema, previously called angioneurotic edema (giant urticaria) is an acute, evanescent, circumscribededema that usually affects the most distensible tissues or mucous membranes
Urticaria
Miao Qing
Department of dermatology
the First teaching hospital , Zheng Zhou university
Course of Dermatology
UrticariaUrticariaConcept
– Urticaria is a vascular reaction of the skin, characteriz
ed by the appearance of wheals, white or red evanes
cent plaques . It is associated with severe itching ,stingi
ng, or pricking sensations.
– In serious cases , it may target gastrointestinal and res
piratory tracts, resulting in abdominal pain , asthma a
nd respiratory problems.
Etiologic factorsEtiologic factors Drugs eg. Penicillin and related antibiotics, aspirin
Food eg. eggs, milk ,meat, chocolate ,cheese, nuts, peanuts, strawberries,tomatoes ,melons,onions and so on;
Infections eg. viruses 、 bacteria, parasites.
Food additives eg. yeast,azo dyes.
Physical factors eg. cold 、 heat 、 sunlight 、 pressure.
Systemic diseases eg. SLE 、 carcinoma
Mental factors eg. emotional stress
PathogenesisPathogenesis
– Type allergyⅠ : the most common– Type allergyⅡ– Type allergyⅢ
– Histamine releaser : aspirin
Immu-nologic
Non-immunologic
Acute urticariaAcute urticaria Clinical features
– they develop quickly and disappear quickly too.
– evanescent wheals last for < 12 h, the whole duratio
n is within 6 weeks
– the wheals may occur in any area of the body.
– mucosal surfaces can also be involved, with related
symptoms including respiratory distress, abdomina
l pain and hoarseness.
– it is serious when occuring on the larynx.
– urticarial lesions are usually pruritic and stinging
Clinical features
wheals ,red or pink
oval or irregular
various sizes
discrete or coalesce
severe itching
Chronic urticariaChronic urticaria
the skin lesions are the same as acute urticaria
the wheals happen frequently, mild or severe
the whole duration often evolves over months to years
the causes are very complicated
Physical urticariasPhysical urticarias
dermatographia(factitious urticaria )
pressure urticaria
cold urticaria
– familial
– acquired
cholinergic urticaria
DermatographiaDermatographia
Clinical features:– it is a sharply localized edema or wheal with a surro
unding erythematous flare occuring within seconds
to minutes after the skin has been stroked.
– A provocative test is performed with a blunt-tipped
object by stroking the skin and observing for a linear
wheal.
– It can arise alone or arise spontaneously after drug-i
nduced urticaria and persist for months.
dermatographia
(facititious urticaria)
linear wheals which is accordant with stroke traces
pruritus
may arise alone or spontaneously after drug-induced urticaria
Cold urticariaCold urticaria
Concept
– exposure to cold may result in edema and whealing
on the exposed areas, usually the face and hands.
– It is classified into two types : acquired and familial
cold urticaria.
Pressure urticariaPressure urticaria
Pressure urticaria is characterized by the development of
swelling with pain that occurs 3 to 12h after local pressure h
as been applied.
It occurs most frequently on the feet after walking and on th
e buttocks after sitting.
The pain and swelling last for 8 to 24h.
Pressure urticaria
caused by localized pressure
swelling with pain
last for 8-24h
often happen on feet and
buttocks
DiagnosisDiagnosisClinical features
– skin lesions are wheals
– they occur quickly, vanish quickly too
– evanescent wheals last for < 12h, the complete resolu
tion is within 6 weeks (acute urticaria)
– severe pruritus
– in some cases , it may have systemic symptoms
TreatmentTreatment Acute urticaria
– antihistamines The first-generation H1 antihistamines Chlorpheniramin
e ( 4~8mg tid) Diphenhydramine (Benadryl 20mg im qd
), Promethazine(phenergan 25mg tid) ; ketotifen(1mg, b
id)
The second-generation H1 antihistamines
Astemizole (10mg qd), cetirizine(10mg qd),loratadine(10
mg qd), terfenadine(60mg bid)
TreatmentTreatment
Acute urticaria– systemic corticosteroid
Prednisone Dexamethasone (5~10mg,im)
– topical therapy topical steroids , eg. Previsone cream, Eloson .
topical antihistamine
TreatmentTreatment Chronic urticaria
– antihistamines The first-generation H1 antihistamines The second-generation H1 antihistamines
combination of H1 and H2 antihistamine
– In general , systemic corticosteroid medications
should be avoided .
AngioedemaAngioedema Concept
– Angioedema , previously called angioneurotic edema (giant u
rticaria) is an acute, evanescent, circumscribed edema that us
ually affects the most distensible tissues or mucous membrane
s.
– It is divided into two types: Acquired angioedema and Heredi
tary angioedema.
EtiologyEtiology
– Acquired angioedema caused by drugs 、 food 、 inhalants and physica
l factors lack of family history
– Hereditary angioedema inherited in an autosomal dominant fashion serum C1 cholinesterase( ChE) inhibitor deficien
cy or dysfunction
Acquired angioedema
happen in loose tissues ( eyelids 、 lips 、 external genitals )
single
circumscribed edema
disappear within 1-3days
It is very serious when occuring in laryngeal
Hereditary angioedema
rarely , family history
happen after trauma
occur in face and limb
lesion is non-pruritic edema
disappear within 1-3days ,recur easily
it is a medical emergency when happen on laryngeal
DiagnosisDiagnosis
– Often occur in the eyelids 、 lips 、 lobes of the ears 、 external genitals and mucous membranes of mouth,
tongue and larynx
– acute , circumscribed 、 evanescent edema,
often disappear within 1-3days
– often begin during the night and found on awakening
– low level of serum C1 esterase inhibitor or deficiency
Treatment Treatment Acquired angioedema
– the same as general urticaria
hereditary angioedema
– fresh frozen plasma
– danazol
– stanazol
– tranexamic acid
Papular urticariaPapular urticaria
concept
– a common disease ,often occur in children . Its skin l
esions are papules or wheals.
etiology– parasites bite , eg.mosquito 、 flea 、 mite 、 punkie 、 b
ug
– allergic food induced
– abnormal gastrointestinal function
Papular urticariaPapular urticariaClinical features
– often happen in children – skin lesions are papules or wheals , 0.5-2cm in size ,
typical lesions look like spindle
– it could generate blister in the center of lesion
– distribution :small distribution :small pruritic papulespruritic papules are mostly on the ar are mostly on the ar
ms and legs , but also occur on the face , the neck and thms and legs , but also occur on the face , the neck and th
e trunk.e trunk.
– about 1 week duration
Papular urticaria
often occur in children
papule or hive, often last for 1 week
blister 、 bulla in the ce
nter of lesions
caused by parasites sting or food
severe itch
DiagnosisDiagnosisClinical features
– often happen in children – skin lesions are papules or wheals , 0.5-2cm in siz
e , typical lesions look like spindle
– distribution :small pruritic papules are mostly on thdistribution :small pruritic papules are mostly on th
e arms and legs , but also occur on the face , the nece arms and legs , but also occur on the face , the nec
k and the trunk.k and the trunk.
– about 1 week duration
Treatment Treatment general treatment
– allergenic food should be avoided– elimination of the insects.
topical therapy– topical steroids, eg. Pevisone cream, Mometasone fu
roate cream (Eloson)– topical antipruritic lotions
Antihistamines– eg.chlorpheniramine , astemizole 、 cetirizine 、 ke
totifen, loratadine
Clinical features
wheals , red or white
oval or irregular
various sizes
evanescent hive
last for<12h
severe itching
dermatographia
(facititious urticaria)
clinical features:
linear wheals which is accordant with stroke traces
pruritus
may arise lonely or arise spontaneously after drug-induced urticaria
Pressure urticaria
clinical features
caused by localized pressure
swelling with pain
last for 8-12h
often happen on feet and
buttocks
Papular urticaria
clinical features
skin lesions:
papule or hive, often last for 1week
distribution alone
caused by parasites sting or food, often occur in children
severe pruritus
Acquired angioedema
clinical features
happen in loose tissues ( eyelids 、 lips 、 external genitals )
single
circumscribed edema
disappear within 1-3days
It is very serious when occuring in laryngeal
Hereditary angioedema
clinical features
rarely seen , has family history
happen after trauma
occur in face and limb
lesion is non-pruritic edema
disappear within 1-3days ,recur easily
serious when happen on laryngeal