Urticaria and Angioedema

Total Page:16

File Type:pdf, Size:1020Kb

Urticaria and Angioedema Urticaria and angioedema ANDREW E. DAVIDSON, MD; S. DAVID MILLER, MD; GUY SETTIPANE, MD; DONALD KLEIN, MD • Urticaria and angioedema are commonly seen in the outpatient setting. Their pathogenesis involves complex cellular and humoral factors. Diagnosis depends on historical information such as duration of symptoms, exacerbating factors, and atopy. While many etiologic factors have been implicated, in most chronic cases no specific etiology is found. This article reviews physical and hereditary syndromes and discusses therapeutic regimens based on the duration and severity of symptoms. • INDEX TERMS: URTICARIA; ANGIONEUROTIC EDEMA • CLEVE CLIN J MED 1992; 59:529-534 HE RELATIVELY COMMON clinical mediated histamine release from cutaneous mast cells syndromes of urticaria and angioedema and basophils is thought to be the primary event in present challenging problems for the prac- allergic urticaria (as seen in food allergies and IgE- ticing physician. Although a spectrum of mediated drug reactions).4,6 In response to specific an- Tdiverse factors has been implicated in their etiology, in tigens or nonspecific stimuli, mast cells release pros- most chronic cases no specific etiologic factor is found. taglandin D2, leukotrienes C4 and D4, and The resulting diagnosis is "idiopathic urticaria." platelet-activating factor, which cause vasodilation and Urticaria is characterized by erythematous, pruritic, increased vascular permeability.4,7 Increased vascular cutaneous elevations that blanch with pressure. The permeability then leads to plasma kinin generation via lesions may occur anywhere on the body. Biopsy of Hageman factor autoactivation.2,8 Mast cells also acute lesions reveals dilated small venules and capil- release enzymes capable of generating and releasing laries in the superficial dermis. Chronic lesions contain bradykinin and kallikrein.2,9 non-necrotizing perivascular mononuclear cell in- Complement components C3a, C4a, and C5a are filtrates, including T cells, monocytes, and mast cells.1 nonspecific factors causing basophil and mast cell his- Clinically, urticaria and angioedema are not dis- tamine release.6 C5a is a chemotactic factor for tinct: they frequently occur together.2,3 Angioedema of eosinophils, monocytes, and neutrophils.2 CI esterase the deep dermal and subcutaneous tissues frequently inhibitor inhibits kinin formation and digestion of C2 involves the face, tongue, extremities, and genitals. and C4.10 These factors may play an important role in Laryngeal edema may be life-threatening. hereditary and acquired angioedema with CI esterase inhibitor deficiency (formerly "hereditary an- PATHOGENESIS gioedema"). Factors released from T lymphocytes and macro- Antibodies, inflammatory cells, complement, his- phages also cause histamine release from mast cells. tamine, kinins, cytokines, and prostaglandins have all Interleukin 3 and granulocyte macrophage colony been implicated in the pathogenesis of urticaria and stimulating factor have been implicated.11 2,4,5 angioedema (Figure): Immunoglobulin E (IgE)- A syndrome of urticaria and angioedema with From the Department of Pediatrics and Medicine, Rhode Island aspirin sensitivity has been described6 which may in- Hospital, Providence. volve increased production of leukotrienes secondary Address reprints requests to A.E.D., Rhode Island Hospital, Department of Pediatrics and Medicine, Division of Allergy, APC to decreased cyclooxygenase activity with shunting of 2 6, 593 Eddy Street, Providence, RI 02903. metabolites into the lipoxygenase pathway. SEPTEMBER • OCTOBER 1992 CLEVELAND CLINIC JOURNAL OF MEDICINE 529 Downloaded from www.ccjm.org on October 1, 2021. For personal use only. All other uses require permission. URI ICARIA AND ANGIOEDEMA • DAVIDSON AND ASSOCIATES implicated. Reactions to penicillins, sulfonamides, analgesics, contrast dye, Nonspecific stimuli sedatives, and diuretics are common (Table 1 ).2,12,13 An- C3a, C4a, C5a giotensin-converting en- Interleukin 3 zyme inhibitors have been Granulocyte macrophage associated with angio- colony activating factor edema, with increased kinin production as a postu- \ lated mechanism.14 Patients Histamine with urticaria and aspirin sensitivity may also react to Prostaglandin D2 other nonsteroidal anti-in- Kinin generation Leukotrienes C,D,E flammatory drugs (in- domethacin, ibuprofen) Platelet activating factor and tartrazine dye.15 These Hageman factor activation patients may tolerate salsa- late or choline magnesium trisalicylate, but some I cross-reactivity has been Increased vascular permeability reported.16 Patients with potentially life-threatening Vasodilation reactions of angioedema FIGURE. Pathogenesis of urticaria and angioedema. and anaphylaxis should avoid all nonsteroidal anti- inflammatory drugs.2 TABLE 1 Foods, including shellfish, nuts, eggs, and milk, are DRUGS IMPLICATED IN ACUTE URTICARIA AND ANGIOEDEMA common causes of acute urticaria and angioedema but only rarely cause chronic problems.2 Viral infections, Amphetamines Heterologous serum Phenylbutazone particularly in children, have been associated with Angiotensin-Converting Hydralazine Polymyxin acute urticaria.17 Seasonal allergen exposure in atopic enzyme inhibitors Insulin Probenecid 3,6 Aspirin Iodinated contrast dye Procaine patients occasionally results in urticaria. Allergic Atropine Isoniazid Protamine Sulfate reactions to Hymenoptera venom may result in ur- Barbiturates Narcotics Quinine 18,19 Cephalosporins Nitrofurantoin Streptokinase ticaria or angioedema. Transfusion reactions have Chymotrypsin Nonsteroidal Sulfonamides also been associated with acute onset of urticaria and Curare anti-inflammatory drugs Suxamethonium angioedema.2 Cyariocobalamin Pancreatin Tartrazine dye Deferoxamine Pancuronium Thiamine Dextran Papain Thiouracil Chronic urticaria Furosemide Penicillins d-Tubocurarine Gallamine Phenothiazines Urticaria of greater than 6 weeks' duration is chronic. In most cases no etiologic factor is found, despite investigation of the patient's history, physical examination, and laboratory evaluation.2,3 CLINICAL SYNDROMES An urticarial rash can develop in patients with sys- temic vasculitis in conjunction with Sjogren's Acute urticaria syndrome, systemic lupus erythematosus, polyarteritis Urticaria and angioedema are prevalent, affecting nodosa, rheumatoid arthritis, cryoglobulinemia, or 10% to 20% of the population at some time in their serum sickness. Untreated infections, particularly viral lives.2,3 The symptoms are transient in most patients hepatitis, infectious mononucleosis, and helminthic and resolve with symptomatic treatment. Drug reac- parasitic infections, have been associated with ur- tions, both IgE- and non-IgE-mediated, are frequently ticaria.6,20"22 Cases of urticaria with bacterial and fungal 530 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 59 NUMBER 5 Downloaded from www.ccjm.org on October 1, 2021. For personal use only. All other uses require permission. URTICARIA AND' ANGIO^^IIM TABLE 2 PHYSICAL SYNDROMES OF URTICARIA AND ANGIOEDEMA Disorder Symptoms Diagnosis Passive transfer Therapy Special characteristics Reference Acquired cold Localized wheal or Ice cube test Positive in Cyproheptadine :lv 2,6,26, urticaria systemic urticaria some cases cryoglobulins, 27,32 with or without cryofibrinogens, angioedema, paroxysmal cold hemoglobinuria, Donath-Landsteiner antibody Familial cold Erythematous History Negative Avoidance, Autosomal dominant 2,6 urticaria burning patches or responds poorly to inheritance papules with pyrexia, antihistamines leukocytosis, arthralgias Cholinergic Multiple 1-2 mm Exercise test, May respond to Overlap with syndromes of 3,6,27, urticaria wheals occur with mecholyl skin hydroxyzine exercise-induced 28,29, exertion, perspiration, test anaphylaxis and food- 30,32 anxiety related exercise-induced anaphylaxis Delayed pressure Local swelling, Sling test Avoidance, responds Occurs in patients with 6,30 urticaria erythema, and poorly to chronic idiopathic pain 4-6 hours antihistamines urticaria after pressure Symptomatic Stroking skin Dermographo- Positive Hydroxyzine, Can be seen in 6,31,32 dermographism produces wheal meter cyproheptadine, control subjects and flare teifenadine Solar urticaria Erythema, pruritus, Monochrometer Positive in Sunscreens, avoidance Different patients are 6,26, papules or wheals some patients sensitive to different 27, wavelengths of light, 32-34 erythropoietic protoporphyria should be excluded Vibratory Edema at site Vortex vibration Negative Avoidance Autosomal dominant 30,32 angioedema of vibration of forearm for response to hereditary form reported 5 minutes antihistamine is variable Aquagenic Pruritic wheals Water compress at — Terfenadine Other syndromes 30,32 urticaria on upper body body temperature hydroxyzine should be ruled out infections have been reported.23 Malignancies as- Hereditary syndromes sociated with urticaria include carcinoma of the colon, Several familial syndromes of urticaria or an- rectum, and lung, B-cell lymphoma, and Hodgkin's gioedema have been described. Familial cold urticaria lymphoma.2 Urticaria can occur with hyperthyroidism is an autosomal-dominant syndrome of cold in- and, rarely, with hypothyroidism.2'24 tolerance. Patients develop papular skin lesions, burn- In urticaria pigmentosa, brown cutaneous macules ing, fever, chills, arthralgias, myalgias, headache, and are present which urticate with stroking (Darier's leukocytosis approximately 30 minutes after cold ex- sign). This disease is primarily seen in children
Recommended publications
  • Vibratory Urticaria
    Vibratory urticaria Description Vibratory urticaria is a condition in which exposing the skin to vibration, repetitive stretching, or friction results in allergy symptoms such as hives (urticaria), swelling ( angioedema), redness (erythema), and itching (pruritus) in the affected area. The reaction can be brought on by towel drying, hand clapping, running, a bumpy ride in a vehicle, or other repetitive stimulation. Headaches, fatigue, faintness, blurry vision, a metallic taste in the mouth, facial flushing, and more widespread swelling (especially of the face) can also occur during these episodes, especially if the stimulation is extreme or prolonged. The reaction occurs within a few minutes of the stimulation and generally lasts up to an hour. Affected individuals can have several episodes per day. Frequency Vibratory urticaria is a rare disorder; its prevalence is unknown. It belongs to a class of disorders called physical urticarias in which allergy symptoms are brought on by direct exposure to factors such as pressure, heat, cold, or sunlight. Physical urticarias have been estimated to occur in up to 5 per 1,000 people. Causes Vibratory urticaria can be caused by a mutation in the ADGRE2 gene. This gene provides instructions for making a protein found in several types of immune system cells, including mast cells. Mast cells, which are found in many body tissues including the skin, are important for the normal protective functions of the immune system. They also play a role in allergic reactions, which occur when the immune system overreacts to stimuli that are not harmful. The specific role of the ADGRE2 protein in mast cells is not well understood.
    [Show full text]
  • Chinese Herbal Medicine for Chronic Urticaria and Psoriasis Vulgaris: Clinical Evidence and Patient Experience
    Chinese Herbal Medicine for Chronic Urticaria and Psoriasis Vulgaris: Clinical Evidence and Patient Experience A thesis submitted in fulfilment of the requirement for the degree of Doctor of Philosophy Jingjie Yu BMed, MMed School of Health & Biomedical Sciences College of Science, Engineering and Health RMIT University August 2017 Declaration I certify that except where due acknowledgement has been made, the work is that of the author alone; the work has not been submitted previously, in whole or in part, to qualify for any other academic award; the content of the thesis is the result of work which has been carried out since the official commencement date of the approved research program; and, any editorial work, paid or unpaid, carried out by a third party is acknowledged. Jingjie Yu __________________ Date 21 August 2017 i Acknowledgements First, I would like to express my deepest gratitude to my parents, Mr Mingzhong Yu and Mrs Fengqiong Lv, for your endless love, encouragement and support throughout these years. I would also like to express my sincere appreciation to my supervisors, Professor Charlie Changli Xue, Professor Chuanjian Lu, Associate Professor Anthony Lin Zhang and Dr Meaghan Coyle. To my joint senior supervisor, Professor Charlie Changli Xue, thank you for providing me the opportunity to undertake a PhD at RMIT University. To my joint senior supervisor, Professor Chuanjian Lu, thank you for teaching me the truth in life and for the guidance you have given me since I stepped into your consultation room in our hospital seven years ago. To my joint associate supervisor Associate Professor Anthony Lin Zhang, I thank you for your continuous guidance and support during my study at RMIT University.
    [Show full text]
  • FULL TEXT BOOK Scientific Program Lecture Summaries Oral Presentations Poster Presentations 1 INVITATION
    FULL TEXT BOOK Scientific Program Lecture Summaries Oral Presentations Poster Presentations 1 INVITATION Dear colleagues, We are pleased to announce the 5th INDERCOS Congress, taking place 12-15 March 2020 in İstanbul-TURKEY. The main topics of this meeting will be “Immunogenetics in Dermatology and Aging”. Through plenaries and parallel workshop sessions, we aim to share insights and experiences and discuss how advances in aesthetic and general dermatology. In order to success this, we have very distinctive international speakers with extensive experience and a range of expertise across aesthetic dermatology and dermatology. Several major histocompatibility complex and nonmajor histocompatibility complex genetic polymorphisms have been identified which may contribute to the inflammatory skin diseases and skin aging. Most of these genetic variants are associated with mechanisms attributed to the pathogenesis of skin disease and aging, including pathways involved in cytokines, chemokine and vitamin regulation and ultraviolet light exposure and other environmental factors. Immunogenetics is a subspeciality of medicine that studies the relationship between genetics and immunology. Immunogenetics helps in understanding the pathogenesis of several autoimmune, malign, infectious skin diseases and also skin aging. 5th INDERCOS congress focuses on the genetic research areas of autoimmune skin diseases such as connective tissue diseases, psoriasis, skin cancers, vasculitis, skin aging and skin infections. Lectures on genetics of cell interaction with immune system, immune response to transplantation, immune based therapies for treatment of cancers and inflammatory skin diseases and aging, antigenic phylogeny of alleles, alloantigens will be discussed. We hope you will be together with us in this fascinating, high quality scientifically educational congress and we look forward to your precious participation and feedback.
    [Show full text]
  • Clinical Practice Guideline 2557 (Urticaria/Angioedema)
    Clinical Practice Guideline 2557 กก (Urticaria/Angioedema) ก ก กกก กก 238 Clinical Practice Guideline Urticaria/Angioedema Clinical Practice Guideline ก: ก ก ก กก : กก ก กก: กก ก ก ก กกก ก ก ก ก กกก: Clinical Practice Guideline Urticaria/Angioedema 239 กก/ กกก ก/ ก/ ก กก/ / ก(spontAneous urticAriA) กก กกก กก กก กกกก กก/ ก ก กก กกกก ก 2552 กกก (wheAl And flAre) /ก (AngioedemA) กก กกก ก ก กก (physicAl) ก ก กก (urticaria) ก (wheAl And flAre) ก ก กกก ก ก (AngioedemA) ก ก กกก ก ก 24 ก กก กกก 24 ก ก ก AnAphylAxis ก กก ก ก กกก (AnAphylActic shock) ก 2 1. (acute urticaria) ก กก 6 2. (chronic urticaria) ก 2 ก กก 6 240 Clinical Practice Guideline Urticaria/Angioedema 1 กก (กก (1) (2)) ก ก ก • / ก ก (SpontAneous urticAriA) (Acute spontAneous urticAriA) ก 6 • / ก ก (Chronic spontAneous urticAriA) กก 6 ก กกก • Cold urticAriA ก ก • DelAyed pressure urticAriA ก ก ก 3-12 กก (Inducible urticAriA or physicAl urticAriA) • HeAt urticAriA • SolAr urticAriA / • SymptomAtic dermogrAphism (mechAnicAl sheAring forces ) ก 1-5 กก • VibrAtory AngioedemA (pneumAtic hAmmer) ก 1-2 • AquAgenic urticAriA • Cholinergic urticAriA ก • ContAct urticAriA กกก ก กกก ก ก 1 กกกกก syndromes กก / 2 Clinical Practice Guideline Urticaria/Angioedema 241 1 กก (ก (2) (3)) Urticaria Angioedema H istory , , ? ก ACEI ? + - - + hereditAry ก AutoinflAmmAtory (HAE) Acquired > 24 ? ก ? disorder ? AngioedemA (AAE) ? + - + - - + - + DiAgnostictests Histology: Inducible vAsculitis
    [Show full text]
  • Dermatological Emergencies: Current Trends in Management
    Dermatological Emergencies: Current Trends in Management Falodun O and Ogunbiyi A Dermatology Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria. SUMMARY loss resulting in various complications. The barrier Emergencies in dermatology are well recognized mechanism against foreign materials is also and are associated with significant morbidity and compromised [1, 2]. mortality. Early recognition of these conditions Dermatologic emergencies to be discussed with institution of prompt medical care can help include the following: in reducing the morbidity and mortality 1. Stevens Johnson syndrome –Toxic epidermal associated with these conditions. This article necrolysis reviews relevant dermatologic emergencies with 2. Pemphigus vulgaris respect to this environment with emphasis on 3. Staphylococcal scalded skin syndrome current trends in management. Prompt and 4. Lepra reaction aggressive management of dermatologic 5. Angioedema emergencies are important to reduce mortality The effective management of each of the related to these skin disorders so as to prevent above listed conditions is possible only when the skin failure. Dermatologic emergencies are underlying pathogenic mechanism is clear to the clinical conditions which lead to increased treating clinician. morbidity and mortality. Recognizing them and the urgency required in their management would TOXIC EPIDERMAL NECROLYSIS AND help in reducing the attendant skin failure that STEVENS JOHNSON’S SYNDROME may arise from these conditions. Both Steven Johnson’s syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are blistering Keywords: Dermatologic emergency, skin conditions of the skin which may result in high failure, management. morbidity and mortality. It is believed that they both represent different spectra of the same disease. INTRODUCTION However, some feel they are different disease entities.
    [Show full text]
  • 86A1bedb377096cf412d7e5f593
    Contents Gray..................................................................................... Section: Introduction and Diagnosis 1 Introduction to Skin Biology ̈ 1 2 Dermatologic Diagnosis ̈ 16 3 Other Diagnostic Methods ̈ 39 .....................................................................................Blue Section: Dermatologic Diseases 4 Viral Diseases ̈ 53 5 Bacterial Diseases ̈ 73 6 Fungal Diseases ̈ 106 7 Other Infectious Diseases ̈ 122 8 Sexually Transmitted Diseases ̈ 134 9 HIV Infection and AIDS ̈ 155 10 Allergic Diseases ̈ 166 11 Drug Reactions ̈ 179 12 Dermatitis ̈ 190 13 Collagen–Vascular Disorders ̈ 203 14 Autoimmune Bullous Diseases ̈ 229 15 Purpura and Vasculitis ̈ 245 16 Papulosquamous Disorders ̈ 262 17 Granulomatous and Necrobiotic Disorders ̈ 290 18 Dermatoses Caused by Physical and Chemical Agents ̈ 295 19 Metabolic Diseases ̈ 310 20 Pruritus and Prurigo ̈ 328 21 Genodermatoses ̈ 332 22 Disorders of Pigmentation ̈ 371 23 Melanocytic Tumors ̈ 384 24 Cysts and Epidermal Tumors ̈ 407 25 Adnexal Tumors ̈ 424 26 Soft Tissue Tumors ̈ 438 27 Other Cutaneous Tumors ̈ 465 28 Cutaneous Lymphomas and Leukemia ̈ 471 29 Paraneoplastic Disorders ̈ 485 30 Diseases of the Lips and Oral Mucosa ̈ 489 31 Diseases of the Hairs and Scalp ̈ 495 32 Diseases of the Nails ̈ 518 33 Disorders of Sweat Glands ̈ 528 34 Diseases of Sebaceous Glands ̈ 530 35 Diseases of Subcutaneous Fat ̈ 538 36 Anogenital Diseases ̈ 543 37 Phlebology ̈ 552 38 Occupational Dermatoses ̈ 565 39 Skin Diseases in Different Age Groups ̈ 569 40 Psychodermatology
    [Show full text]
  • Healthcare Bulletin
    Happy New Year 2003 JANUARY 2003 VOL 11 NO 1 ISSN 1681-5552 healthcare bulletin ◆ Common Dermatological Disorders ◆ Eczema ◆ Pruritus ◆ Urticaria ◆ Product Profile: Oni® ◆ Glimpse of MSD Activities 2002 ◆ SQUARE in International Business ◆ Medical Updates Published as a service to medical professionals by JANUARY 2003 VOL 11 NO 1 IN THIS ISSUE: Common Dermatological Disorders ... Page 1 Eczema ... Page 3 Pruritus ... Page 7 Urticaria ... Page 12 Product Profile: Oni® ... Page 16 Glimpse of MSD Activities 2002 ... Page 17 From the Desk of Managing Editor SQUARE in International Business ... Page 19 Dear Doctor: Medical Updates ... Page 20 "! You have already noticed Greetings everyone and Happythe New SQUARE Year! Welcome to this edition of " the new look of this issue! We have updated our design to make it more enjoyable for you. Our vision and determination is to give you the most accurate, " is "Dermatology" special and includes reliable andthe easy SQUARE to understand health information every time. This “the SQUARE” issue of " updated information on common dermatological disorders, Managing Editor pruritus, eczema, urticaria. Besides, our regular features comprise, Omar Akramur Rab MBBS, FCGP, FIAGP, FRSH medical updates, product profile and others. Executive Editor We welcome your suggestions and comments to help us provide Latifa Nishat the highest quality and most useful service. In addition we MBBS appreciate all of the comments and feedback we have received Members of the Editorial Board from those who have taken the time to write. Muhammadul Haque We believe you will enjoy reading this publication and that MBA hope and A. H. Mahbub Alam the contents provided will prove helpful towardsSQUARE your goal of M Pharm, PhD optimum health! Shaokat Zaman MBBS We, on behalf of the management of Information Assistance pray that you have a safe and healthy life throughout all of Md.
    [Show full text]
  • Angioedema Associated with Urticaria Can Be a Silent Killer
    erg All y & of T l h a e n r Genel et al., J Aller Ther 2013, 4:1 r a p u y o J Journal of Allergy & Therapy DOI: 10.4172/2155-6121.1000128 ISSN: 2155-6121 Review Article Open Access Angioedema Associated with Urticaria can be a Silent Killer Sur Genel1*, Sur Lucia2, Floca Emanuela3, Sur Daniel3 and Samasca Gabriel4 1Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania 2Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania 3Resident Physician, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania 4Emergencies Clinical Hospital for Children, Cluj-Napoca, Romania Abstract Urticaria and angioedema are common diseases in children and adults. Erythematous swelling of the deeper cutaneous and subcutaneous tissue is called angioedema. Urticaria is characterized as the appearance of erythematous, circumscribed, elevated, pruritic, edematous swelling of the upper dermal tissue. Urticaria may occur in any part of the body, whereas angioedema often involves face, extremities or genitalia. Urticaria is considered acute if symptoms are present for less than 6 weeks. In chronic urticaria symptoms are longer than 6 weeks. Acute urticaria has been reported to be the common type in childhood and chronic urticaria is more frequent in adults. Urticaria and angioedema are a frequent cause of emergency room visit but few patients need to be admitted. The basic mechanism involves the release of diverse vasoactive mediators that arise from the activation of cells or enzymatic pathways. Histamine is the best known of these substances, and response consisting of vasodilatation (erythema), increased vascular permeability (edema) and an axon reflex that increases reaction.
    [Show full text]
  • Ana M. Giménez-Arnau Howard I. Maibach Editors Diagnosis And
    Updates in Clinical Dermatology Series Editors: John Berth-Jones · Chee Leok Goh · Howard I. Maibach Ana M. Giménez-Arnau Howard I. Maibach Editors Contact Urticaria Syndrome Diagnosis and Management Updates in Clinical Dermatology Series Editors: John Berth-Jones Chee Leok Goh Howard I. Maibach More information about this series at http://www.springer.com/series/13203 Ana M. Giménez-Arnau Howard I. Maibach Editors Contact Urticaria Syndrome Diagnosis and Management Editors Ana M. Giménez-Arnau, PhD Howard I. Maibach, MD Hospital del Mar - Institut Mar Department of Dermatology d’Investigacions Mediques University of California San Francisco Universitat Autònoma de Barcelona San Francisco, CA, USA (UAB) Department of Dermatology Barcelona, Spain ISSN 2523-8884 ISSN 2523-8892 (electronic) Updates in Clinical Dermatology ISBN 978-3-319-89763-9 ISBN 978-3-319-89764-6 (eBook) https://doi.org/10.1007/978-3-319-89764-6 Library of Congress Control Number: 2018946545 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
    [Show full text]
  • ACP Michigan Chapter, Medical Student Day 2019 Poster #1 Category
    ACP Michigan Chapter, Medical Student Day 2019 Poster #1 Category: Clinical Vignette School: American University of Integrative Sciences School of Medicine Clerkship Director: Don Penny, MD, MSC Presenter: Abed Dabaja Additional Authors: Abed Dabaja; Spencer L Franchi DO; Emman Dabaja MD MPH; Ali H. Dabaja DO Tetanus: When Clinical Suspicion is Enough Tetanus is a severe and potentially fatal infection caused by the bacterium Clostridium tetani. Classifications of tetanus include generalized tetanus, neonatal tetanus, cephalic tetanus, and localized tetanus. JZ is a 18-year-old male junkyard worker who presented to the emergency department with witnessed episodic muscle contraction, apneic spells, inability to open his mouth, fever, and difficulty swallowing. He had sustained a penetrating injury to his right foot with scrap metal approximately seven days prior to symptom onset. On initial evaluation, the patient notably exhibited risus sardonicus and significant arching of his back, accompanied by approximately five minutes of intermittent apneic spells and diaphoresis, all of which resolved spontaneously. He exhibited a clean, well healed right puncture wound to the right foot. Lab work did not demonstrate leukocytosis or elevated CRP. A Mandibular x-ray was unremarkable. His Tetanus vaccination status was unknown. In conjunction with the history of recent penetrating trauma and exclusion of an alternative diagnoses, the patient was diagnosed with acute generalized tetanus. Emergency department physician initiated tetanus immunoglobulin, metronidazole, and lorazepam as needed. He was placed in the intensive care unit for close monitoring of respiratory status, given potential deterioration of diaphragmatic muscles and history of apneic periods. In the ICU, patient was evaluated daily by the neurology service, where he was eventually discharged without recurrence of spasms or any other sequelae.
    [Show full text]
  • Chronic Urticaria and Angioedma • the Know the Provocative Challenges for Physical Urticaria • Give an Appropriate Investigation • Give Proper Management Urticaria
    URTICARIA Kumutnart Chanprapaph MD, MSC Clinical Instructor Division of dermatology Ramathibodi hospital Objectives • Give a diagnosis of urticaria • To recognize the cause of acute, chronic urticaria and angioedma • The know the provocative challenges for physical urticaria • Give an appropriate investigation • Give proper management Urticaria • Wheals and flare reaction: pruritus (itch) Wheal‐ localized intracutaneous edema Flare‐ surrounding area of erythema • AS A RULE: individual lesions come and go rapidly, within 24 hours • Leaves no trace Angioedema • Deep swelling of the dermis or subcutaneous tissue of the skin or mucosa • Painful , not well defined • The lesions often last for 2 to 3 days Cutaneous mast cell Release histamine in response to • compound 48/80 • C5a • morphine • codeine • substance P (SP) • vasoactive intestinal peptide (VIP) • somatostatin Most important Most important Vascular permeability in skin • H1 histamine receptors‐ 85% • H2 histamine receptors‐ 15% Urticaria Ordinary urticaria Urticarial lesion • Acute uticaria (<6wk) • Cutaneous disease • Chronic urticaria (>6wk) • Systemic disease Main features distinguishing common urticaria from other urticarial lesions Common urticaria Other urticarial lesions Typical wheals: Atypical wheals: • Erythematous, edematous • Infiltrated plaques lesions • Persistent>24‐36 hrs • Transient < 24‐36 hrs • Symmetrical distribution • Asymmetrical distribution • Resolution with sighs eg • Complete resolution hypo/hyperpigmentation, scarring No other primary lesions No other
    [Show full text]
  • In Vivo Studies of the Pathogenesis of Cold Urticaria, Cholinergic
    T HE JOURNAL OF INVESTIGATIVE DERMATOLOGY 67:327-332, 1976 Vol. 67, No.3 Copyright © 1976 by The Williams & Wilkins Co. Printed in U.S.A . IN VIVO STUDIES OF THE PATHOGENESIS OF COLD URTICARIA, B CHOLINERGIC URTICARIA, AND VIBRATION-INDUCED SWELLING ALLEN P. KAPLAN, M.D., AND MICHAEL A. BEAVEN, PH.D. Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, and Pulmonary Branch, National Heart and Lung Institute, National Institutes of Health, Bethesda, Maryland, U. S. A. The disorders generally classified as physical normally subsides during the next 5 min. The urticarias include cold urticaria, local and general­ patient with cold urticaria usually complains of ized (cholinergic) heat urticaria, dermographism, pruritus in the area between 2 and 4 min after pressure urticaria, and vibration-induced angio­ removal of the ice cube and develops a large hive edema. These diseases have the" common property the size of the ice cube within 10 min. Figure 1 of being reproducibly induced by physical stimuli shows the result of a positive ice cube test demon­ and are not associated with an increased incidence strating swelling which encompasses the area of allergic disorders such as hay fever or extrinsic where the ice cube was placed as well as the area asthma in which offending allergens are identifia­ where ice water dripped down the patient's arm. ble. Studies of these diseases have involved at­ In order to identify the mediators released in tempts to identify circulating antibodies that cold urticaria, patients were studied in the follow­ might be responsible for the observed sensitivity or ing manner.
    [Show full text]