DOCSLIB.ORG

Fig I High Power Ofpanniculitis Showing Acute Inflammatory I

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fig I High Power Ofpanniculitis Showing Acute Inflammatory I 29 Section ofDernmatology 1279 little cedema. The changes are not those of then appeared. Similar transient remissions were erythema multiforme.' produced by methysergide 8 mg daily and cyproheptadine 16 mg per day. Comment This patient shows yet another new manifestation Clinical features: The lesions are easily palpable, caused by cold and based on a vasculitis. The firm, tender, deep-seated nodules on the legs or clinical and histological picture is completely arms. The overlying epidermis shows slight separate from those seen in cold urticaria and in redness over early lesions. Sites of previous delayed type of sensitivity from cold (Sarkany & nodules show no scarring or any other residual Turk 1965, Sarkany 1967). change. REFERENCES Sarkany I Investigations: Detailed investigations including (1967) Proc. roy. Soc. Med. 60, 496 blood count, sedimentation rate, plasma proteins Sarkany I & Turk J L (1965) Proc. roy. Soc. Med. 58, 622 and Wassermann reaction were normal. LE cells and antinuclear factor were not detected. Dr T J Ryan: The permeability of the vessels of nor- mal skin is influenced by cold and this may be more obvious in pathological states when other factors influencing permeability are introduced. A patient shown here in 1963 (Ryan, 1964, Proc. roy. Soc. Med. 57, 45), and later at a meeting of the British Associa- tion of Dermatology in 1966, was very much disabled by purpura which was predominantly influenced by cold. Each lesion was initially urticarial and became purpuric only after several hours. The only significant finding was an abnormal degree of painful wealing following the intracutaneous inoculation of her own platelets. This did not occur after intracutaneous inoculation of whole blood or red cell stroma. Vasculitis as exhibited by today's patient is pre- sumably caused by some immunological or pharma- cological imbalance. Cold may be encouraging the increase in permeability of the blood vessels. It is not Fig I High power ofpanniculitis showing necessarily the primary cause of the condition. acute inflammatory i,ifiltrate. x 75 Dr Macmillan: Inoculation of the patient's own blood did not reproduce the lesions. Histology: There is an acute panniculitis (Fig 1). Subcutaneous fat is infiltrated with acute in- flammatory cells. No vasculitis is seen and both the dermis and epidermis appear normal. Comment Recurrent Non-scarring Pressure Panniculitis We have been unable to find a previous descrip- I Sarkany FRCP and A L Macmillan MB MRCP tion of an exactly similar clinical picture asso- (Royal Free Hospital, London) ciated with the histology of panniculitis. The name of recurrent non-scarring pressure panni- Woman aged 37. Housewife culitis is proposed for this entity. History: For five years she has had crops of tender nodules on the legs and arms. The palms and soles are spared. These nodules are asym- metrical and appear spontaneously or 2-12 hours Dr P J Ashurst: I note that this patient has had an enlarged thyroid for approximately the same period after local pressure or a knock. There is no as her skin disease. Would it not be worth while systemic disturbance. The nodules persist for up investigating the possibility of an abnormality in to eight days and resolve completely. Treatment thyroid metabolism? with antihistamines was ineffective. Prednisone in a daily dose of 15 mg suppressed the appear- Dr Macmillan: I interpreted the lump in her neck as an ance of fresh nodules for 48 hours but, in spite of enlarged lymph gland as it did not move on swallow- continued administration of the drug, new lesions ing and was not connected to the thyroid gland. 1280 Proc. roy. Soc. Med. Volume 62 December 1969 30 Dr Harvey Baker: Have you entirely excluded auto- Alopecia Mucinosa erythrocytic purpura? Another possibility might be Dr A J Miller (for Dr K V Sanderson) DNA autosensitivity (Chandler & Nalbandian, 1966, Amer. J. med. Sci. 251, 145). Scleroderma ?Morphea Dr Macmillan: The patient does not show purpura Dr J P Ellis (for Dr S C Gold) and inoculation of her own blood does not reproduce her lesions. Reticulum Cell Sarcoma Dr B J Leppard Dr Harvey Baker: The reaction produced by injection (for Dr K V Sanderson) of blood may depend on the depth of the injection. Pemphigoid in Mother and Newborn Baby The President: We have a patient with pressure Dr K V Sanderson urticaria in whom polycythxmia has been found. I note that your patient has no blood disorder. Giant Pigmented Nevus of Arm Dr Macmillan: The patient has never shown urticaria. Dr Brian Russell The lesions are a panniculitis. There are further differences in the clinical picture. In contrast to Angioendothelioma (Lymphatic Type) pressure urticaria this patient does not develop lesions Dr S C Gold on the palms after clapping, on the soles after walking, or after carrying heavy weights, and the nodules which Basal Cell Naevus Syndrome she develops persist for much longer than the lesions Dr A J Miller (for Dr S C Gold) of pressure urticaria. Congenital Ectodermal Defect with Nail Dystrophy and Resorption of Terminal Phalanges The following cases were also shown: Dr E Swart (for Dr H T Calvert) (1) Striate Eruption (2) Comedo Naevus Systemic Sclerosis: Polymyositis: (3) Pustular Psoriasis Calcinosis Cutis: Carpal Tunnel Syndrome (4) Epidermolysis Bullosa Dr J Almeyda and Dr C Barnes Dr M I Keir (for Dr F R Bettley) (for Dr Brian Russell) Meeting June 191969 The following cases were shown: Vitiligo with a Raised Edge Dr J Kalivas (for Dr R H Marten) Pyoderma Gangrenosum Dr M I Keir (for Dr R H Meara) Case for Diagnosis - ?Sweet's Syndrome (Recurrent Neutrophilic Dermatosis) (1) Peyronie's Disease. Dupuytren's Contracture Dr C M Ridley (2) Lichen Nitidus Dr D I Porter (for Dr P D Samman) Congenital Anomaly: Cutaneous Pigmentation and Atrophy with Partial Webbing of Digits Lichen Nitidus Dr P D Samman Dr J A Savin (for Dr P D Samman) (1) Collins - von Hippel - Lindau Haemangiomatosis Multiple Pigmented Macules (2) Punctate Keratoderma Dr D C Macmillan (for Dr H R Vickers) Dr P W M Copeman Lichen Sclerosus with Irritation Epidermodysplasia Verruciformis Dr C J Guerrier (for Dr H R Vickers) Dr E Swart (for Dr H T Calvert).
Load more

Recommended publications
  • Urticaria - Primary Care Treatment Pathway
    DORSET MEDICINES ADVISORY GROUP Urticaria - Primary Care Treatment Pathway Urticaria – also known as hives or nettle rash – is a raised, itchy rash that can occur on just one part of the body or be spread across large areas. The weals of urticaria last less than 24 hours although patients may develop new weals on a daily basis. If urticaria clears completely within six weeks, it is known as acute urticaria. Urticaria occurring for more than six weeks is referred to as chronic urticaria. Most cases of chronic disease occur without an obvious trigger (chronic spontaneous urticaria). Some urticaria has a physical trigger such as pressure (symptomatic dermographism or delayed pressure urticaria), cold or exercise (cholinergic urticaria), or may be drug induced (e.g. by NSAIDS, ACE inhibitors and opioids). All forms of urticaria can be treated with antihistamine although physical urticaria is less likely to respond to treatment than spontaneous urticaria. Most cases of urticaria settle spontaneously within two years but the condition can last for decades in some patients. Referral criteria Refer routinely to dermatology if patients are not responding to standard treatment (see primary care treatment below, up to step 4), they can then be considered for immunomodulation treatment such as ciclosporin (can be very useful for patients thought to have an autoimmune basis for their urticaria), methotrexate or omalizumab. The diagnosis of urticaria is primarily clinical therefore do not routinely refer for allergy testing. The British Association of Dermatologists (BAD) has produced a patient information leaflet which covers this in detail for patients. PRIOR TO SPECIALIST REFERRAL -conduct a full blood count (FBC), erythrocyte sedimentation rate (ESR), thyroid function tests (TFTs), liver function tests (LFTs), and Helicobacter pylori screening (if gastrointestinal symptoms are present).
    [Show full text]
  • Etiology, Classification, and Treatment of Urticaria
    CONTINUING MEDICAL EDUCATION Etiology, Classification, and Treatment of Urticaria Kjetil Kristoffer Guldbakke, MD; Amor Khachemoune, MD, CWS GOAL To understand urticaria to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical classification of urticaria. 2. Recognize how to diagnose urticaria. 3. Identify treatment options. CME Test on page 50. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. December 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Guldbakke and Khachemoune report no conflict of interest. The authors discuss off-label use of colchi- cine, cyclophosphamide, cyclosporine, dapsone, intravenous immunoglobulin, methotrexate, montelukast sodium, nifedipine, plasmapheresis, rofecoxib, sulfasalazine, tacrolimus, thyroxine, and zafirlukast. Dr. Fisher reports no conflict of interest. Urticaria is among the most common skin dis- autoimmune mechanisms are now recognized as a eases. It can be acute, chronic, mediated by a cause of chronic urticaria. A search of the PubMed physical stimulus, or related to contact with an database (US National Library of Medicine) for urticant.
    [Show full text]
  • 10 Chronic Urticaria As an Autoimmune Disease
    10 Chronic Urticaria as an Autoimmune Disease Michihiro Hide, Malcolm W. Greaves Introduction Urticaria is conventionally classified as acute, intermittent and chronic (Grea- ves 2000a). Acute urticaria which frequently involves an IgE-mediated im- munological mechanism, is common, its causes often recognised by the patient, and will not be considered further. Intermittent urticaria – frequent bouts of unexplained urticaria at intervals of weeks or months – will be dis- cussed here on the same basis as ‘ordinary’ chronic urticaria. The latter is conventionally defined as the occurrence of daily or almost daily whealing for at least six weeks. The etiology of chronic urticaria is usually obscure. The different clinical varieties of chronic urticaria will be briefly considered here, and attention will be devoted to a newly emerged entity – autoimmune chronic urticaria, since establishing this diagnosis has conceptual, prognostic and the- rapeutic implications. Contact urticaria and angioedema without urticaria will not be dealt with in this account. Classification of Chronic Urticaria The clinical subtypes of chronic urticaria are illustrated in the pie-chart of Fig. 1. The frequency of these subtypes is based upon the authors’ experience at the St John’s Institute of Dermatology in UK. Whilst there may well be mi- nor differences, it is likely that the frequency distribution of these subtypes will be essentially similar in most centres in Europe and North America (Grea- ves 1995, 2000b). However, our experience suggests that the incidence of angioedema, especially that complicated by ordinary chronic urticaria is sub- stantially lower in Japan and south Asian countries (unpublished observation). 310 Michihiro Hide and Malcolm W.
    [Show full text]
  • ALLCHRONIC URTICARIA About ANGIOEDEMA
    ALLCHRONIC URTICARIA about& ANGIOEDEMA WHAT IS CHRONIC URTICARIA? may be a result of an immune system disorder. In very rare cases, The term chronic urticaria (CU) is another term for “chronic CU/angioedema can be identified as a reaction to a medication, hives.” Hives are an inflammation of the skin that results from cells food, insect or infection. Even when the cause cannot be identified, in your body releasing histamine and other allergic chemicals into there are common stimuli that may worsen or exacerbate the condi- the bloodstream. They appear as clusters of raised, red or white tion such as: welts that tend to be very itchy. Chronic hives are defined as hives • allergies (food, environmental) • medications that last more than six weeks, or may briefly go away, but often • temperatures (hot and cold) • illnesses recur frequently. About 40% of people with chronic urticaria often • pressure • sun exposure have another condition known as angioedema. There are several subtypes of CU, including cold urticaria, pressure urticaria, and HOW IS CU/ANGIOEDEMA DIAGNOSED? cholinergic urticaria. CU occurs in about 1% of the US population. The diagnosis of CU is based mostly on history of symptoms and physical exam that is done by either your pediatrician or an WHAT ARE THE SYMPTOMS OF CU? allergist. Although there are not specific laboratory tests that can be done to diagnose this condition, there are blood tests and allergy CU presents as hives - small or large patches that may be round, tests that can be done to identify triggers or rule out other condi- irregular shaped, rings, or may change shape throughout the day.
    [Show full text]
  • Urticaria, Angio-Oedema and Anaphylaxis
    CME Dermatology Urticaria, angio-oedema and anaphylaxis The simplest working classification is to separate urticarias into four categories (Table 2): Urticarial lesions (ie areas of superficial Clive EH Grattan MA MD FRCP, Consultant ordinary Dermatologist, Norfolk and Norwich swelling) are also seen in skin diseases physical University Hospital, Norwich other than urticaria (eg some drug reac- tions, bullous pemphigoid). In these vasculitic urticaria (urticarial Clin Med JRCPL 2002;2:20–23 conditions, the lesions do not show the vasculitis) rapid fluctuation which characterises contact urticaria. urticaria. They will not be considered Angio-oedema may be a feature of Urticaria, angio-oedema and anaphy- further in this article. most patterns of urticaria and, for the laxis are distinct clinical entities caused Angio-oedema implies deeper vascular most part, can be considered together by transient plasma leakage from small leakage producing swellings predomi- with urticaria. However, it is worth con- blood vessels. When the affected vessels nantly affecting the subcutis. They tend sidering angio-oedema separately when are superficial the result is a raised, itchy to be large, pale and painful rather than it occurs without weals (Table 3) because swelling of the skin known as a weal. red and itchy, and last longer than weals. it may then be a presentation of Involvement of deeper vessels produces Angio-oedema is a cause of distressing C1esterase inhibitor (C1 inh) deficiency tender subcutaneous and submucosal oropharyngeal swellings but may occur or a drug reaction. swellings known as angio-oedema. anywhere on the integument including Generalised plasma exudation leading to the genitalia. shock is a feature of anaphylaxis but also Ordinary urticaria Anaphylaxis is defined by a life-threat- occurs in anaphylactoid reactions and ening fall in blood pressure, difficulty Ordinary urticaria is a useful collective the capillary leak syndrome.
    [Show full text]
  • Urticaria and Angioedema
    URTICARIA AND ANGIOEDEMA What are the aims of this leaflet? This leaflet has been written to help you understand more about urticaria and angioedema. It tells you what they are, what causes them, what you can do about them, and where you can find out more about them. What is urticaria and angioedema? Urticaria is common, and affects about 20% of people at some point in their lives. It is also known as hives or nettle rash. The short-lived swellings of urticaria are known as weals (see below) and typically any individual spot will clear within 24 hours although the overall rash may last for longer. Angioedema is a form of urticaria in which there is deeper swelling in the skin, and the swelling may take longer than 24 hours to clear. An affected individual may have urticaria alone, angioedema alone, or both together. Both are caused by the release of histamine from cells in the skin called mast cells. When angioedema occurs in association with urticaria, the two conditions can be considered part of the same process. When angioedema occurs on its own, different causes need to be considered. There are different types of urticaria of which the most common form is called ‘ordinary or idiopathic urticaria’. In this type no cause is usually identified and often patients have hives and angioedema occurring together. Ordinary urticaria with or without angioedema is usually divided into ‘acute’ and ‘chronic’ forms. In ‘acute’ urticaria/angioedema, the episode lasts from a few days up to six weeks. Chronic urticaria, by definition, lasts for more than six weeks.
    [Show full text]
  • Aafp Fmx 2020
    Challenging Pediatric Rashes Richard P. Usatine, MD, FAAFP Professor, Family and Community Medicine Professor, Dermatology and Cutaneous Surgery University of Texas Health, San Antonio 1 ACTIVITY DISCLAIMER The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note that medical information is constantly changing; the information contained in this activity was accurate at the time of publication. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The AAFP disclaims any and all liability for injury or other damages resulting to any individual using this material and for all claims that might arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material 2 might contain recommendations/guidelines developed by other organizations. Please note that although these guidelines might be included, this does not necessarily imply the endorsement by the AAFP. 2 1 Disclosure Statement It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest. If conflicts are identified, they are resolved prior to confirmation of participation.
    [Show full text]
  • Chronic Urticaria It’S More Than Just Antihistamines! Randy D
    CE/CME Chronic Urticaria It’s More Than Just Antihistamines! Randy D. Danielsen, PhD, PA, DFAAPA, PA-C Emeritus, Gabriel Ortiz, MPAS, PA-C, DFAAPA, Susan Symington, MPAS, PA-C, DFAAPA The discomfort caused by an urticarial rash, along with its unpredictable course, can interfere with a patient’s sleep and work/school. Adding to the frustration of patients and providers alike, an underlying cause is seldom identified. But a stepwise treatment approach can bring relief to all. Randy D. Danielsen is Professor and Dean CE/CME INFORMATION rticaria, often referred to as hives, is a of the Arizona School Earn credit by reading this article and common cutaneous disorder with a life- 1 of Health Sciences, successfully completing the posttest time incidence between 15% and 25%. and Director of the U Center for the Future at www.mdedge.com/clinicianreviews/ Urticaria is characterized by recurring pruritic of the Health ce/cme/latest. Successful completion wheals that arise due to allergic and nonallergic Professions at A.T. is defined as a cumulative score of at reactions to internal and external agents. The Still University in least 70% correct. Mesa, Arizona. name urticaria comes from the Latin word for Gabriel Ortiz This program has been reviewed and “nettle,” urtica, derived from the Latin word uro, practices at Breathe is approved for a maximum of 1.0 hour meaning “to burn.”2 America El Paso in of American Academy of Physician Urticaria can be debilitating for patients, who Texas and is a former Assistants (AAPA) Category 1 CME AAPA liaison to the may complain of a burning sensation.
    [Show full text]
  • Indian Journal of Dermatology, Venereology & Leprology
    Indian Journal of Dermatology, Venereology & Leprology Journal indexed with SCI-E, PubMed, and EMBASE | | VVolo l 7744 IIssues s u e 2 MMar-Apra r- A p r 220080 0 8 C O N T E N T S EDITORIAL Management of autoimmune urticaria Arun C. Inamadar, Aparna Palit .................................................................................................................................. 89 VIEW POINT Cosmetic dermatology versus cosmetology: A misnomer in need of urgent correction Shyam B. Verma, Zoe D. Draelos ................................................................................................................................ 92 REVIEW ARTICLE Psoriasiform dermatoses Virendra N. Sehgal, Sunil Dogra, Govind Srivastava, Ashok K. Aggarwal ............................................................. 94 ORIGINAL ARTICLES A study of allergen-specific IgE antibodies in Indian patients of atopic dermatitis V. K. Somani .................................................................................................................................................................. 100 Chronic idiopathic urticaria: Comparison of clinical features with positive autologous serum skin test George Mamatha, C. Balachandran, Prabhu Smitha ................................................................................................ 105 Autologous serum therapy in chronic urticaria: Old wine in a new bottle A. K. Bajaj, Abir Saraswat, Amitabh Upadhyay, Rajetha Damisetty, Sandipan Dhar ............................................ 109 Use of patch
    [Show full text]
  • 100 CASES in Dermatology This Page Intentionally Left Blank 100 CASES in Dermatology
    100 CASES in Dermatology This page intentionally left blank 100 CASES in Dermatology Rachael Morris-Jones PhD PCME FRCP Consultant Dermatologist & Honorary Senior Lecturer, King’s College Hospital, London, UK Ann-Marie Powell Consultant Dermatologist, Department of Dermatology, St Thomas’ Hospital, London, UK Emma Benton MB ChB MRCP Post-CCT Clinical Research Fellow, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Trust, London, UK 100 Cases Series Editor: Professor P John Rees MD FRCP Dean of Medical Undergraduate Education, King’s College London School of Medicine at Guy’s, King’s and St Thomas’ Hospitals, London, UK First published in Great Britain in 2011 by Hodder Arnold, an imprint of Hodder Education, a division of Hachette UK 338 Euston Road, London NW1 3BH http://www.hodderarnold.com © 2011 Rachael Morris-Jones, Ann-Marie Powell and Emma Benton All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: Saffron House, 6–10 Kirby Street, London EC1N 8TS Hachette UK’s policy is to use papers that are natural, renewable and recyclable products and made from wood grown in sustainable forests. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin.
    [Show full text]
  • View / Download Pdf Version of This Article
    The diagnosis and treatment of URTICARIA Urticaria is a common condition, in which the majority of cases are non-allergenic. A focused clinical history and physical examination are the most useful tools when diagnosing and treating urticaria. Specific triggers are often not found, therefore extensive diagnostic testing is not recommended, unless there is strong evidence to suspect a specific trigger. In some cases, urticaria may be a symptom of an underlying systemic disease and it is important to be aware of this possibility and to refer for further investigation when necessary. 6 Classification and aetiology of urticaria in primary care with urticaria will have chronic urticaria.6 Chronic urticaria occurs more frequently in adults, and in Urticaria is the term used to describe a group of skin conditions, women (approximately 60% of cases).1 It is estimated that in characterised by the presence of wheals. Approximately one 40% of people with chronic urticaria, there is evidence of an in five people experience urticaria (commonly referred to as autoimmune process, and in 20% there is evidence of a physical hives) at some stage in their life.1, 2 In many cases, a specific stimulus,1 although a specific cause is often not found. trigger for the urticaria is not found. In rare cases, urticaria may be a sign of systemic disease, such as an autoimmune Physical urticaria occurs in a localised area after contact with condition. a physical stimulus. Individual episodes usually resolve within a two hour period, but physical urticaria often persists as a The two main classifications of urticaria are: chronic, recurring condition.3 Dermatographism (skin writing) Ordinary (spontaneous) urticaria – which can be acute or is the most common form of physical urticaria, triggered by chronic firm stroking or scratching of the skin, or contact with clothes 3 Physical urticaria or other objects (Figure 1).
    [Show full text]
  • Urticaria: Diagnostic and Treatment Considerations
    Urticaria: Diagnostic and Treatment Considerations Adam Friedman , MD, FAAD Associate Professor of Dermatology Residency Program Director Director of Translational Research Disclosure Slide • Consulting/Ad board: Sanova works, Oakstone institute, Exeltis, Glossier, Loreal, La Roche Posay, Galderma, Amgen, Aveeno, Valeant, Microcures, Nano Bio-Med, Biogen, Pfizer, Nerium, G&W Laboratories, Novartis, Occulus, Intraderm, Encore, Ferndale • Speaker: Amgen, Valeant • Grants: Valeant Urticaria: The Basics • Affects 20% of population • Occurs across the age spectrum • Sometimes possible to identify a trigger such as food, drug, insect sting or infection • More than 2/3 of cases are self- limiting Characteristics: The Basics • Pruritic – Burning • Erythematous – Often exhibit central pallor • Oval, round or irregular shape or plaques • Plaques “move” to different locations over minutes to hours – < 24 hours • Typically leaves no PIPA/scarring – Other than from scratching Pathophysiology: What we actually know • Reaction mediated by activated mast cells and basophils in superficial dermis – When activated release histamine --> vasodilators Greaves MW. Int Arch Allergy Appl Immunol 2002; 127: 3-9. Histamine and Pruritus: A Simple Relationship Cerebral cortex Thalamus Histamine receptor Lateral spinothalamic Histamine tract Activated Dermo-epidermal mast cell junction Spinal cord C-fiber • Histamine receptors located on C-fiber neurons neurons • Histamine binding triggers an itch impulse A bit more complicated… So where are we? Do you have the right
    [Show full text]