Term
| Specialized Erythema conditions (common) (3): |
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Definition
- Urticaria (hives)
- Erythema Multiforme
- Erythema Migrans |
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Term
| Specialized erythema conditions (uncommon, 3): |
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Definition
- Erythema Gyratum Repens
- Erythema Annulare Centrifugum
- Erythema Ab Igne |
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Term
| The specific ___ of specialized erythema is key to diagnosis. Specialized erythema represents a __ pattern to an underlying cause (like Erythema multiforme being caused by herpes simplex infection). |
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Definition
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Term
| Uriticaria aka hives are characterized by evanescent edematous __ and __. Acute urticaria is often caused by an __ __ __. A cause is rarely found for chronic urticaria (greater than 6 weeks). Treat with ___. |
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Definition
- papules and plaques
- upper respiratory infection
- antihistamines |
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Term
| Hives generally do not have __ and are __ demarcated. They are/are not pruritic. |
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Definition
- do NOT have scale
- well demarcated
- are pruritic |
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Term
| Hives are often on the trunk or extremities and rarely stay in one place long. An individual hive lasts in one place less than 24 hours. |
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Definition
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Term
| If you see a white hue around urticaria, it likely ___. |
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Definition
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Term
| Hives are very common, greater than 20% of population experience hives. Acute hives is defined as less than __ __ duration. Acute hives may present to the Er. Food can cause hives, __ often cause hives. |
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Definition
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Term
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Definition
Itching is a prominent symptom
Ask about over-the-counter medications as well as prescription drugs
An individual hive last less than 24 hours
Initial therapy antihistamines |
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Term
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Definition
Very important
In acute urticaria, pts present with pruritus ( itching) and urticaria (hives)
Drug history is very important, including the OTC products
History of ingestion of new food or drinks
1st time or reoccurring hives
Check for specific medicines, vitamins, analgesics, laxatives, herbs, aspirin, NSAIDs, artificial sweetners
Any and all new products |
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Term
| Physical Urticaria causes: |
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Definition
Dermographism
Delayed pressure
Heat and Stress
Stress
Cold
Physical exercised induced
Sunlight (Solar)
Aquagenic |
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Term
| Demographism is common form of __ urticaria. |
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Definition
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Term
| Cholinergic urticaria occurs after __ and ___. |
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Definition
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Term
| If patient has hives, fever, and arthralgia, think __ __ and __ __. However, __ to __ of the time, no cause is found for hives. |
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Definition
- serum sickness
- viral hepatitis
- 50-80% |
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Term
SHORT ACTING ANTIHISTAMINES CAN HELP WITH ACUTE ONSET OF HIVES: BENADRYL
CHRONIC URTICARIA: ZYZOL OR CLARINEX, LONG ACTING ANTIHISTAMINE, MORE POTENT, FOR MORNING
ALLEGRA IS NOT GOOD FOR URTICARIA
DOXEPIN IS GOOD FOR NIGHT, BUT COMPLETELY KNOCKS THEM OUT, VERY POTENT |
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Definition
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Term
| For a patient with hives, give them non-sedating antihistamines in the day and a sedating at night for __ _. After it is clear for at least one week, drop the night time, but keep the day time for __ more weeks. |
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Definition
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Term
| Uriticarial lesions should last less than 24 hours. If they do last more than 24 hous in the same location, think ___ ___ which will resolve with a __ and will have ___ and __ instead of itching. |
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Definition
- urticarial vasculitis
- bruise
- tenderness and burning |
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Term
| Urticarial lesions differential diagnosis? |
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Definition
Erythema Multiforme
Juvenile Rheumatoid Arthritis
Erythema Marginatum
Urticarial Vasculitis |
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Term
| Erythematous target lesions that last longer than 24 hours: |
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Definition
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Term
| The most common cause of erythema multiforme minor is __ __ in teenagers and young adults. |
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Definition
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Term
| Patient comes in with transient hives about 2-3mm and salmon colored and with symptoms of arthritis. These appear with a fever spike. Dx? |
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Definition
| Juvenile Rheumatoid Arthritis |
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Term
| This rash is associated with acute rheumatic fever. It is transient and rarely itchy. It is an erythematous, annular, and macular papular rash. |
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Definition
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Term
| With urticarial vasculitis, a __ would show vasculitis. Additional work up is needed, may have underlying malignancy. |
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Definition
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Term
| annular urticarial plaques with residual purpura: |
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Definition
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Term
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Definition
- clinical evalulation
- good history
- CBC
- CMP
- LFT
- Sed Rate
- sometimes a 4 mm punch biopsy |
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Term
Chronic Urticaria
Rarely associated with malignancy
Lab tests are usually of little value in eliciting an urticarial cause.
Biopsy is rarely needed. |
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Definition
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Term
| What 3 drugs can make urticaria worse and should patients avoid with urticaria? |
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Definition
- aspirin
- codeine
- NSAIDs |
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Term
| Punch biopsy of urticaria results: |
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Definition
Rarely of much value
May show vasodilatation, dermal edema, and a sparse perivascular inflammatory
infiltrate composed mainly of lymphocytes, and sometimes admixed with eosinophils |
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Term
| Urticaria will have __ epidermis, ___ edema, some infiltrate around __ __. |
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Definition
- normal epidermis
- papillary edema
- dilated vessels |
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Term
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Definition
Discontinue drugs suspected
Avoid Aspirin and NSAIDs and Codiene
Oral Antihistamines:
Atarax (Hydroxyzine) 10-25mg qid,
Claritin (Lortadine) 10mg daily,
Zyrtec ( Citirizine) 10mg daily,
Allegra (Fexofenadine)180mg qid
Oral Tricyclic drugs: Doxepin 25mg bid
Occasionally: Nifedipine 10-40mg modified release qid, Prednisone 0.5mg/kg daily
(go down on dosage of antihistamines for elderly- more side effects) |
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Term
Acute urticaria usually resolves in 2 weeks
Chronic Urticaria lasts over 6 weeks to years
Drug-induced urticaria resolves within few days of removing the drug
Physical urticaria are prolonged
No specific complication, just intense itching
Hives can occur prior to life-threatening anaphylactic reaction, but very rare |
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Definition
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Term
| Immunological production of urticaria is __ __ mediated and ___ mediated. Non-immunlogical production of urticaria is caused by agents that cause __ __ ___ like __ and __ media. |
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Definition
- IgE mediated
- complement mediated
- mast cell degranulation
- opiates and radiocontrast media |
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Term
| All pathways for urticaria result in release of __ (a vasoactive substance) that alter vacular __ and produce __ __, which appears clinically as a hive. |
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Definition
- histamine
- permeability
- dermal |
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Term
| Erythema multiforme have target lesions that have ___ __ that are diagnostic. Recurrent disease is most often precipated by __ __ __. Involvement of two or more mucosal surfaces signifies a poorer prognosis (Stevens-Johnson Syndrome). |
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Definition
- concentric rings
- herpes simplex infection |
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Term
| Erythema multiforme is an immunologic reaction in the skin possibly triggered by circulating __ __. A variety of skin lesions, erythematous plaques, blisters, and ___ lesions. |
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Definition
- immune complexes
- target lesions |
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Term
| Involvement of mucus membranes is Erythema Multiforme __ aka __ __ __, usually caused by drugs. |
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Definition
- Major
- Stevens-Johnson Syndrome |
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Term
| Erythema Multiforme is most commonly aused by drugs or infection. It is more common in __ __ and __ __. Antibiotics especially __ and __ cause this. Anticonvulsants also cause it. |
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Definition
- older children and young adults
- penicillin and sulfas |
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Term
| Erythema mulitforme has a __ onset (less than 24 hours). 50% of time associated with herpes infection. Lesions are __ and have a ___ sensation. Herpes infection may preceede EM by about 1 week. |
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Definition
- rapid
- pruritic
- burning |
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Term
| ___ ___ infection is another precipating infection factor for EM. They will have a history of preceding fever and cough. Most severe Steven Johnsons is usually associated with ___ related or drug-induced. |
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Definition
- Mycoplasm pneumoniae
- Mycoplasma |
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Term
| Erythema Multiforme physical findings: |
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Definition
Mild to severe presentation
Target lesions on palms and soles and sometimes other areas
Target lesions have 3 zones of color and are diagnostic of EM
Mild form may not be symmetrical
Severe form is generalized and involves mucous membranes, oral mucosa, lips, conjunctivae. Painful oral erosions. |
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Term
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Definition
Urticaria (2 zones, last < 24 hours)
Viral Exantham( monomorphous, less red, more confluent, more central body)
Staphylococcal Scalded Skin Syndrome
Pemphigus and Pemphigoid |
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Term
| Erythema Multiforme lab work up: |
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Definition
- Tzanck smear or viral culture
- chest xray
- acute and convalescent cold agglutinnin titers for Mycoplasm infection
- No helpful lab for drug-induced EM
- Skin biopsy usually not needed for diagnosis |
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Term
| Therapy for Erythema Multiforme: |
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Definition
Usually treatment does not alter course of the disease
Treat infection if it is present.
If Mycoplasma infection, use erythromycin, azithromycin or clarithromycin
For recurrent Herpes infection,
Valtrex (Valacyclovir) 500mg 1 bid or Famvir (famciclovir) 125mg 1 bid, maintance anti-viral treatment to avoid EM
Discontinue responsible drug, if any |
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Term
| If EM is caused by a Mycoplasma infection, treat with ___, ___, or __. |
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Definition
- erythromycin
- clarithromycin
- azithromycin |
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Term
| Therapy for Stevens-Johnson Syndrome: |
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Definition
- supportive care
- high dose systemic steroids
- hydration
- prevent secondary infection
- provide pain relief
- oral viscous Lidocaine or Dyclonine liquid for control of painful oral lesions |
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Term
| Mild EM resolves in __ to __ __. |
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Definition
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Term
| Severe EM resolves in __ to __ __. |
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Definition
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Term
| Death with Stevens-Johnson Syndrome varies from 0% - 15%, major complications are infection and fluid loss, severe cases are treated like burn patients |
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Definition
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Term
| EM entire skin involvement is called __ __ __. |
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Definition
| toxic epidermal necrolysis |
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Term
| Erythema Multiforme pathogenesis: |
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Definition
Circulating immune complexes
Antigen from the drug or infectious agent
IgM Immune complexes
Possible also cellular immune mechanism |
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Term
| Erythema migrans is the hallmark sign of __ __, the most common tick-borne illness in the US. It is caused by __ __, which is transmitted by the __ tick species. Treatment with ___ avoids the late complications of __ __. |
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Definition
- Lyme's Disease
- Borrelia burdorferi
- Ixodes tick
- antibiotics
- notably arthritis |
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Term
| Erythema migrans is an ___ red patch with __ clearing. |
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Definition
- expanding
- central
True Lymes disease have to be up in Northeast to get it.
Antibiotic treatment of Lymes disease works and cures it.
Expnding red patch with central clearing where tick bite was. No scale. Well demarcated border and not raised like a fungal infection. This is just erythema that spreads. |
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Term
| Erythema migrans must be greater than __ __ in order to receive this diagnosis. Greater than 60% of those with Lyme's Disease get this. |
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Definition
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Term
| Later complications of Lyme's Disease include: |
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Definition
| - muskuloskeletal, nervous system, and cardiovascular problems |
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Term
| Lyme's disease is the most frequently reported __ born disease in the US and is most common in the __ _ to __ __ in ___ states. |
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Definition
- arthropod
- late spring to early fall (May to September)
- Northeastern |
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Term
| Erythema migrans history: |
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Definition
Symptoms onset 3-30 days after tick bite
Some pts do not remember tick bite
Some pts develop fever, myalgia, arthralgia, headache, malaise or fatigue
The Erythema Migrans skin lesion is usually asymptomatic, but spreading |
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Term
| Erythema migrans physical findings: |
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Definition
Lesion occurs at site of tick bite, usually waistband, intertriginous areas and extremities
> 5cm, but up to 68cm, average 15cm, expanding over days and weeks
Central punctum of tick bite may be present or absent
Macular border with central clearing
Less common papular border, alternating rings of erythema and clearing and center that is intensely erythematous, vesicular, purpuric, necrotic or even ulcerated
Multiple lesions in 15% of pts |
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Term
| Erythema Migrans differential diagnosis: |
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Definition
Cellulitis, tender and warm
Tinea corporis, scale KOH positive
Granuloma annulare, asymptomatic
Fixed drug reaction, no central clearing, reoccurring
Insect bite reaction, central puncta, transient, itchy |
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Term
| Lab tests: Erythema Migrans is diagnosed __ in endemic areas. Serologic tests (___) for __ and __ __ __ __ antibodies, __ to __ weeks after symptoms. If ElISA is positive or equivocal, the __ __ is used to confirm diagnosis. PCR testing is best done on __ __ or __ fluid (expensive and not widely availabe). |
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Definition
- clinically
- ELISA
- IgM and IgG anti-Borrelia burgodorferi antibodies, 2-4 weeka after symptoms
- Western Blot
- cerebrospinal fluid or synovial fluid |
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Term
| Screening test for Lyme's Disease: |
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Definition
| - ELISA for IgM and IgG anti-Borrelia burgdorferi antibodies (2-4 weeks after symptoms) |
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Term
| confirmation test for Lyme's Disease: |
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Definition
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Term
| In stage 2 of Lyme's disease __ __ occurs (picture of patient unable to lift upper eyelids). |
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Definition
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Term
| Erythema migrans prevention: |
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Definition
| Ideal treatment is prevention of tick bites, avoidance, protective clothing, DEET repellant, and prompt tick removal within 24 hours |
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Term
| Erythema Migrans treatment: |
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Definition
All patients with Lyme's Disease require antibiotic treatment:
- Doxycycline 100 mg, 1 bid for 10-21 days for adults
- Amoxicillin 500 mg, 1 tid for 10-21 days as alternative for adults
- Erythromycin 250 mg, 1 qid for 10-21 days only as 3rd line treatment
- Kids under age 12, Amoxicillin 50mg/dg daily tid for 10-21 days |
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Term
| The course and complications of Lyme Disease are similar to ___. Without treatment, erythema migrans will resolve on its own in one __ and w/o treatment the disease will progress to second and third stages. Stage 1 is __, stage 2 is ___, and stage 3 is __ __. |
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Definition
- syphilis
- one month
- localized
- disseminated
- late persistent |
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Term
| Stage 2 __ __ Erythema migrans has __ spread. Symptoms include being systemically ill with __, __, __, __, and __. Other symptoms are arthritis, meningitis, cranial neuritis(Bell's palsy), lymphadenopathy, carditis, atrioventricular conduction defects. |
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Definition
- Early Disseminated
- hematogenous
- fever, chills, headache, athralgia, and fatigue |
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Term
| Stage 2 early disseminated erythema migrans: |
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Definition
Neurologic symptoms occur weeks to months and affect 15-20% of pts
Cardiac involvement occurs within weeks and affects 4-8%
Arthritis is the most common symptom and occurs usually at 6 months, but as early as 2 weeks and as late as 2 years
60% of pts with intermittent asymmetric arthritis affects primarily large joints, knee |
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Term
| Stage 3 Late persistent Lyme Disease: |
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Definition
Continual arthritis, lasting for more than 1 year
Chronic CNS involvement may occur with ataxia and mental disorder. |
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Term
| Stage 3 Erythema Migrans treatment: |
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Definition
Treatment of Cardiac and Neurologic manifestations:
Ceftriaxone 2gm iv daily for 14-21 days
Treatment for Lyme arthritis:
Doxycycline 100mg 1 bid for 30 days or Amoxicillin 500mg 1 qid for 30 days |
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Term
| Erythema Migrans pathogenesis: |
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Definition
Caused by Borrelia burgdorferi, a spirochete carried by Ixodes ticks
Ixodes dammini (deer tick), northeastern and midwestern USA
Ixodes pacificus, western USA
Ixodes ricinus, Europe
Preferred host in North America is white-footed mouse, for the larval tick
Preferred host is the white-tailed deer for the adult tick, thus the name deer tick |
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Term
| __ __ __ represents a paraneoplastic figurative erythema. Most common underlying neoplasms are __,__, or __. Rash may occur before or after cancer diagnosis. You will see __ __ __ __which can grow up to 1 cm daily. Lesions resolve when malignancy treated. |
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Definition
- Erythema Gyratum Repens
- breast, lung, or esophagus
- striking gyrate red plaques |
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Term
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Definition
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Term
| __ __ __ is characterized by annular red plaques that expand centrifugally. There are 2 forms: 1. a superficial form with a trailing edge of white scale, or 2. a deep form with infiltrated borders and no scale. Most common locations are __, __, and __. Can be episodic or last for months. Cause is uknown and treatment not that good. It is possibly a response to a distant fungal infection. This is more common in __. |
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Definition
- Erythema Annulare Centrifugum
- axillae, hips, and thighs
- males |
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Term
| Annular red plaques with trailing edge of scale; |
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Definition
| Erythema Annulare Centrifugum |
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Term
| __ __ __ is skin changes to chronic exposure to a heating source. Pathophysiology is unknown. Presents as a __ _ ___ erythema and is __. Low but present risk of developing __ __ __ within the lesion. Prevent by removing heat source. . |
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Definition
- Erythema Ab
- net-like reticulated erythema and is hyperpigmented
- sqaumous cell carcinoma |
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