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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
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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.
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APPEARANCE OF
SYMPTOMS Wheals (raised areas surroundedby a red base) from urticaria canappear anywhere on the surface of
the skin. Wheals may be pinpoint in size, orseveral inches in diameter.Fluid leakage from superficialblood vessels
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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
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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.
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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
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Drug-induced urticaria
Urticaria by infection orenvironmental agent
Dermatographic urticaria
Pressure or delayed pressure
Classification By Cause
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Classification …
Chronic cold urticaria
Solar urticaria
Water-induced urticaria
Exercise urticaria
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Investigations
General : CBP , ESR, GSE, GUE, urine and bloodsugar, liver and renal function tests.
Skin test: commonly used in patient with chronicurticaria.
Certain disease commonly associated withchronic urticaria as sinus infection, UTI,hyperthyroidism, intestinal warms, internalmalignancy, lymphoma, pregnancy and chronicexposure to external allergen.
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It can be difficult to determine appropriatemedications, since some, such as loratadine, require aday or two to build up to effective levels, and thecondition is intermittent and outbreaks typically clear upwithout any treatment.
Treatment plans for urticaria involve being aware of
one's triggers
Antihistamines such as diphenhydramine may beused.
MANAGEMENT
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H1-H2 Receptor Antagonists
85/15 ratio of skin H1/H2 receptors
Combination of anti H1&2 providesadditional treatment benefit
Doxepin blocks both receptors andis a more potent anti-H1 blocker thandiphenhydramine or hydroxizine
Sedation may limit usefulness ofdoxepin
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Zafirlukast and montelukast superior to placebo
in treatment of chronic urticaria.
Have not been compared to therapy withantihistamines.
No additional effect once maximal antihistamineeffect achieved.
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Oral sympathomimetics (e.g., terbutaline) studied to reduce
erythema / swelling
Side effects substantial (insomnia, tachycardia)
Efficacy low
SYMPATHOMIMETIC
AGENTS
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CORTICOSTEROIDS
Indicated when inadequate response tohistamine receptor blockers and leukotrienereceptor antagonists
Effective but with substantial side effects
Alternate day therapy if must be used
One approach – start 15-20 mg qod andtaper to 2.5-5mg q three weeks, d/c after 4-5months
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Experimental
Therapies
Cyclosporine at low doses (2.5-3 mg/kg) effective andsteroid sparing
High dose (6 mg/kg) very effective but with severe sideeffects
Other agents less well studied include sulfasalazine,
hydroxychloroquine and dapsone, IV IgG
Plasmapheresis for patients with anti-IgE Ab effective butimpractical for long-term treatment
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Recommendations
Laboratory workup rarely necessary (except thyroidevaluation)
Antihistamines mainstay of therapy (H1and H2)
Nonsedating at low/high doses effective for mild/moderatedisease
Older, sedating antihistamines more effective for severeurticaria and/or angioedema
Minimize systemic corticosteroids (alternate day)
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Contact DermatitisIt 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 orirritant is activated by sunlight.
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Symptoms
Localized rash or irritation of the skin caused by contactwith a foreign substance.
Only the superficial regions of the skin are affected incontact dermatitis.
Contact dermatitis results in large, burning, and itchy rashes,and these can take anywhere from several days to weeks toheal.
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Causes
The most common causes of allergic contactdermatitis a
The alkyl resorcinols in Grevillea banksii andGrevillea 'Robyn Gordon' are responsible forcontact dermatitis re plants of theToxicodendron genus.
Other common causes of irritant contactdermatitis are harsh (highly alkaline) soaps,detergents, and cleaning products.
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Classification
Irritant contact dermatitis
Allergic contact dermatitis
Photocontact dermatitis
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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.