Urticaria and Drug Reactions Quiz
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Questions and Answers

What is the defining characteristic of urticaria?

  • Papules
  • Scaling plaques
  • Vesicles
  • Erythematous wheals (correct)

    • Which of the following is NOT a type of urticaria?

  • Spontaneous
  • Cold
  • Solar
  • Psoriasis (correct)

    • What is the duration of acute urticaria?

  • 6 months
  • More than 6 weeks
  • 1-3 weeks
  • Less than 6 weeks (correct)

    • What is the duration of chronic urticaria?

    <p>More than 6 weeks (A)</p> Signup and view all the answers

    What percentage of chronic urticaria cases are idiopathic?

    <p>50% (C)</p> Signup and view all the answers

    What is the most common autoimmune association with chronic urticaria?

    <p>Thyroid disease (A)</p> Signup and view all the answers

    What is the name of the bacteria that can be associated with chronic urticaria?

    <p>Helicobacter pylori (D)</p> Signup and view all the answers

    What type of urticaria is triggered by pressure applied to the skin?

    <p>Delayed pressure urticaria (C)</p> Signup and view all the answers

    What type of urticaria is triggered by scratching the skin?

    <p>Dermographism (B)</p> Signup and view all the answers

    Which of the following could trigger urticaria?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a characteristic of Red Man Syndrome?

    <p>Generalized, macular erythema on the back of the neck spreading to the trunk, face and arms (C)</p> Signup and view all the answers

    Which drug is most commonly associated with Fixed Drug Eruption?

    <p>NSAIDs (A)</p> Signup and view all the answers

    Which of the following is a characteristic of Photoallergic reaction?

    <p>Can resemble lichen planus (B)</p> Signup and view all the answers

    Which of the following is NOT a common drug associated with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN)?

    <p>Doxycycline (A)</p> Signup and view all the answers

    Which of the following is a characteristic of Erythema Multiforme Minor?

    <p>No/Mild mucosal involvement (C)</p> Signup and view all the answers

    Which of the following is NOT true about Pemphigus Vulgaris?

    <p>The blister is tense and cannot move/tear (D)</p> Signup and view all the answers

    Which of the following is a characteristic of Dermatitis Herpetiformis?

    <p>Cutaneous manifestation of Celiac Disease (C)</p> Signup and view all the answers

    Which of the following is a potential treatment for Bullous Pemphigoid?

    <p>Rituximab (A)</p> Signup and view all the answers

    Which of the following is NOT a possible trigger for urticaria?

    <p>Zolair (A)</p> Signup and view all the answers

    Which of the following is true about the treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN)?

    <p>Early discontinuation of the offending drug is crucial (D)</p> Signup and view all the answers

    What is the most important factor in determining the treatment for a melanoma in situ (MIS)?

    <p>The depth of invasion (A)</p> Signup and view all the answers

    Which of the following is a risk factor for squamous cell carcinoma?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a characteristic of a venous stasis ulcer?

    <p>Irregular borders and minimal pain (C)</p> Signup and view all the answers

    What is the first-line treatment for lichen sclerosus?

    <p>Medium/high potency topical steroids (D)</p> Signup and view all the answers

    Which of the following conditions is associated with dark hyperkeratosis and velvety patches or plaques?

    <p>Acanthosis Nigricans (A)</p> Signup and view all the answers

    Which type of biopsy is typically used for lesions above the skin surface?

    <p>Shave biopsy (B)</p> Signup and view all the answers

    Which of the following is a risk factor for pressure ulcers?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the most common type of melanoma?

    <p>Superficial spreading melanoma (A)</p> Signup and view all the answers

    What is the treatment for superficial basal cell carcinoma?

    <p>Electrodesiccation and curettage (ED&amp;C), 5-FU, or surgery (B)</p> Signup and view all the answers

    Which of the following conditions is considered a precancerous lesion?

    <p>Actinic keratosis (A)</p> Signup and view all the answers

    Flashcards

    pylori treatment

    Four treatment stages involve antihistamines, Dupixent, and Allergist referral.

    Common drug reactions

    Most common is Penicillin, most severe is Bactrim.

    Morbilliform rash

    Generalized rash appearing 7-14 days after drug exposure, common with penicillin and Bactrim.

    Red Man Syndrome

    Adverse reaction to Vancomycin causing erythema and pruritus, often requiring antihistamines.

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    Fixed Drug Eruption

    Round patches that appear after exposure to a drug, typically NSAIDs, worsening with continued use.

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    Photosensitivity types

    Phototoxic (no sensitization) and photoallergic (requires prior sensitization), caused by various drugs.

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    Erythema Multiforme

    Skin condition categorized into minor (HSV linked) and major (systemic symptoms), treat with antivirals.

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    Stevens-Johnson Syndrome

    Severe drug reaction causing mucosal involvement and skin peeling, prognosis improves with prompt drug discontinuation.

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    Pemphigus Vulgaris

    Autoimmune blistering disease in the spinosum; tests for desmoglein indicate severity.

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    Dermatitis Herpetiformis

    Skin manifestation of Celiac Disease marked by itchy vesicular papules, treated by gluten elimination.

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    Urticaria

    A skin condition characterized by red, itchy welts called wheals.

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    Erythematous Wheals

    Red, raised welts that are itchy and can appear suddenly on the skin.

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    Types of Urticaria

    Includes spontaneous, cold, solar, delayed pressure, and dermographism types.

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    Acute Urticaria

    Urticaria lasting less than 6 weeks.

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    Chronic Urticaria

    Urticaria that lasts more than 6 weeks.

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    Idiopathic Urticaria

    Urticaria with no identifiable cause, representing 50% of chronic cases.

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    Autoimmune Urticaria

    Urticaria associated with autoimmune diseases, found in 40-50% of cases.

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    Thyroid and Urticaria

    Thyroid conditions can be associated with autoimmune urticaria.

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    Dermographism

    A type of urticaria where skin becomes raised after being scratched.

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    Triggers for Urticaria

    Common triggers include foods, medications, infections, and environmental factors.

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    Actinic Keratosis

    Precancerous lesions caused by sun exposure, rough and flaky.

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    Basal Cell Carcinoma

    The most common skin cancer, rarely metastasizes, linked to sun exposure.

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    Squamous Cell Carcinoma

    Red, scaly lesions; second most common skin cancer, high metastasis risk.

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    Melanoma

    Most dangerous skin cancer; characterized by asymmetry, border, color, diameter, evolution.

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    Merkel Cell Carcinoma

    Rare, aggressive skin cancer presenting as a large nodule.

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    Kaposi Sarcoma

    Rare cancer related to blood vessels, associated with HHV8, often in immunocompromised.

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    Melasma

    Symmetrical hyperpigmented patches on sun-exposed skin, often in women.

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    Acanthosis Nigricans

    Dark, velvety patches linked to insulin resistance and obesity.

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    Venous Stasis

    Most common vascular ulcers, often painless, located on legs due to venous insufficiency.

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    Shave Biopsy

    Removes surface-level lesions, typically for superficial skin cancers.

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    Study Notes

    Urticaria

    • Types include spontaneous, cold, solar, delayed pressure, and dermographism
    • Acute urticaria lasts less than six weeks
    • Chronic urticaria lasts more than six weeks
    • 50% of cases are idiopathic (no known cause) and do not need further investigation
    • 40-50% of cases are autoimmune, potentially associated with thyroid issues or H. Pylori infection
    • Treatment options include antihistamines (first-line, daily; second-line, four times daily), Dupixent, doxycycline, or cyclosporine
    • If a trigger is known, removing it is important
    • If only angioedema is present, a work-up is necessary
    • Generally, no constitutional symptoms, but if present, a work-up is recommended

    Common Drug Reactions

    • Penicillin is a common culprit
    • Bactrim is a severe reaction

    Morbilliform Rashes/Exanthematous

    • Typically appear 7-14 days after drug exposure
    • Often associated with penicillin and Bactrim use
    • Red man syndrome is a particular reaction to vancomycin
    • Symptoms include macular erythema that spreads from the back of the neck to the trunk, face, and arms
    • Pruritus (itching) and sometimes hypotension may occur
    • Treatment options include antihistamines, topical steroids, slow-infusion

    Fixed Drug Eruption

    • Characterized by round or oval patches that remain fixed to one spot
    • Usually appears 1-2 weeks after the first exposure to the trigger drug
    • NSAIDs, particularly naproxen, are a common cause
    • More lesions might appear with continued exposure

    Photosensitivity

    • Phototoxic reactions appear as a severe sunburn-like rash
    • This is not related to prior sensitization and is often caused by NSAIDs, doxycycline/tetracycline, hydrocortisone
    • Photoallergic reactions require prior sensitization and can resemble lichen planus and are often caused by topical sulfa medications

    Erythema Multiforme

    • Minor cases are associated with HSV (Herpes Simplex Virus) but may not have systemic symptoms or mucosal involvement
    • Major cases associated with Mycoplasma but can also be HSV
    • Associated with systemic symptoms and significant mucosal involvement
    • Treatment includes valacyclovir (antiviral), topical steroids, and oral steroids (if severe)

    Stevens-Johnson Syndrome & Toxic Epidermal Necrolysis (TEN)

    • Drug-induced eruptions occurring 7-21 days after drug use
    • Includes mucosal involvement, organ damage, and skin peeling
    • Frequent culprits include allopurinol, sulfa medications, and anticonvulsants
    • Body surface area involvement helps distinguish Stevens-Johnson Syndrome (less than 10% body surface area) from Toxic Epidermal Necrolysis (over 30% body surface area)
    • Prognosis is significantly affected by how quickly the drug is discontinued
    • SCORTEN (a scoring system) helps predict mortality risk on days 1 and 3

    Pemphigus Vulgaris

    • Autoimmune blistering disease affecting the spinosum layer of the epidermis

    Bullous Pemphigoid

    • Autoimmune subdermal blistering disease at the dermal-epidermal junction
    • Blisters are tense and cannot tear
    • Associated with neurological disorders like multiple sclerosis, stroke, bipolar disorder, dementia, and Parkinson's disease
    • Treatment options vary from topical steroids and doxycycline in mild cases to topical steroids, oral steroids, and rituximab in moderate-severe cases

    Actinic Keratosis

    • Small, dry, rough, erythematous, flaky lesions that are often felt before seen
    • Precancerous lesions caused by sun exposure
    • Ten percent of these lesions progress to squamous cell carcinoma
    • Treatments include cryotherapy (for smaller lesions) and 5-fluorouracil (5FU) for multiple lesions

    Basal Cell Carcinoma

    • Most common, rarely metastatic skin cancer
    • Increased risk with sun exposure and genetic factors
    • Superficial BCC affects the epidermis; treatment includes electrodessication and curettage, 5-fluorouracil (5-FU), or surgery.
    • Nodular BCC is red, raised, scaly, exhibits telangiectasias, bleeds easily, and presents with a pearly shiny appearance; excision, Mohs micrographic surgery, or topical 5-FU are indicated for treatment.

    Squamous Cell Carcinoma

    • Second most common skin cancer
    • Can be red, scaly, or plaque-like
    • Most dangerous form with a high likelihood of metastasis
    • Risk factors include sun exposure, HPV, smoking, immunocompromised status, lichen sclerosis/planus, and chemical exposure
    • Treatment options include topical 5-fluorouracil (5-FU), surgical excision (in situ), and MOHS surgery (invasive)

    Melanoma

    • Most common type is superficial
    • Follow-up with dermatologist for 2 years after diagnosis is critical
    • Dysplastic nevi (atypical moles) can be associated with increased risk
    • Mild/moderate risk, reassurance is recommended; severe cases may require intervention (MIS)

    Merkel Cell Carcinoma

    • Very aggressive and rare skin cancer
    • Characterized by a large nodule arising unexpectedly
    • Treatments include punch or shave biopsies and referral to oncology

    Kaposi Sarcoma

    • Rare cancer affecting blood vessels and lymph vessels of the skin
    • Associated with HHV8
    • More common in people with a history of immunocompromised or organ transplant

    Melasma

    • Symmetric hyperpigmented patches on sun-exposed areas of the body (e.g., face, cheeks, forehead, and neck)
    • Often a light to dark brown color
    • Risk factors include female gender, pregnancy, and oral contraceptives.
    • Treatment options include hydroquinone, topical steroids, and long-term sun protection.

    Post-Inflammatory Hyperpigmentation

    • Hyperpigmented macules or patches following skin trauma or injury
    • Typically resolves within 6-12 months
    • Treatment includes sunscreen and topical treatments (hydroquinone, corticosteroids, azelaic acid)

    Acanthosis Nigricans

    • Hyperpigmented, velvety patches or plaques
    • Frequently seen on the neck and folds
    • Associated with insulin resistance, obesity, and metabolic disorders
    • Treatment options include topical retinoids, keratolytics (e.g., lactic acid, salicylic acid), and microdermabrasion

    Vitiligo

    • Depigmented (loss of pigment) macules and patches
    • Destruction of melanocytes
    • Risk factors include thyroid disease and family history
    • Treatment includes sunscreen, topical steroids, tacrolimus ointment, and biologics (like opzelura cream)

    Lichen Sclerosus

    • Ivory white, itchy atrophic papules with a pink rim
    • Risk factors include autoimmune dysfunction, prior skin diseases, and family history of thyroid disease/anemia/areata.

    Pressure Wounds (Decubitus Ulcers)

    • Bed sores due to prolonged pressure on bony prominences
    • Common in patients with limited mobility
    • Risk factors include sensory deficits, age, poor nutrition, and immobility
    • Stages range from intact skin to full-thickness tissue loss
    • Treatment focuses on prevention and management of infection and pressure

    Arterial and Venous Ulcers

    • Arterial ulcers present as punched-out lesions with severe pain (especially with movement)
    • Venous ulcers are associated with a history of venous insufficiency with symptoms like pain, heaviness, and/or discoloration
    • Diagnosis can include evaluation of the ankle-brachial index, while venous ulcers are diagnosed with venous duplex ultrasonography
    • Common risk factors include smoking, diabetes, prior DVT/VTE, obesity, immobility.

    Stasis Dermatitis

    • Dry, pruritic (itchy), scaly, hyperpigmented rash on the lower extremities caused by venous insufficiency

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    Description

    Test your knowledge on the types and treatments of urticaria, as well as common drug reactions associated with medications like penicillin and Bactrim. Understand the differences between acute and chronic urticaria, and learn about morbilliform rashes that arise post-drug exposure. Explore the various triggers and management strategies involved in these conditions.

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