Urticaria and Angioedema PDF

Urticaria and angioedema Ass. Prof. Dr. Murtadha Hashim Raheem M.B.Ch.B.F.I.B.M.S ‫بورد ( دكتوراه ) اختصاص االمراض الجلديةوالتناسلية‬ Email: [email protected] [email protected] Facebook : murtadha hashim. ✓Urticaria is extremel...

Urticaria and angioedema Ass. Prof. Dr. Murtadha Hashim Raheem M.B.Ch.B.F.I.B.M.S ‫بورد ( دكتوراه ) اختصاص االمراض الجلديةوالتناسلية‬ Email: [email protected] [email protected] Facebook : murtadha hashim. ✓Urticaria is extremely common that affects 15- 25% of the population at some points in their lives. ✓Characterized by the appearance of wheals, the primary lesion of the disease, which are short-lived swellings occur anywhere on the body.  pathogenesis ✓Urticaria results from the release of histamine and other vasoactive substances from mast cells and basophils in the dermis. ✓These substances cause extravasation of plasma into the dermis, leading to the urticarial lesion.  Clinical features ✓Urticarial lesions are arise suddenly, often within a few minutes, and last 6–24 hours (transience ). ✓Pruritic or burning. ✓They may assume odd, polycyclic, annular and geographic forms. ▪ Occasionally urticarial lesions stay for days rather than hours and leave a brownish stain. This type of urticaria is due to involvement of small blood vessels and is known as urticarial vasculitis. Urticaria  firm pressure over a track with a blunt object such as a key over the skin of the back may produce blanching, then redness, then a weal. This phenomenon, which is an exaggeration of the normal ‘triple response’, causes itching and is known as dermographism. Triple response of lewis Some causes of urticaria  Types Of Urticaria ❑Ordinary urticaria A common skin problem responsible for 8O % of all types, occur in both sexes and in all ages. ❖ Acute urticaria. last less than two months. Each attack is of short duration. The attack is usually associated with sever itching or pricking sensation sometimes end with anaphylactic shock. ❖ Chronic urticaria Last more than two months. High recurrence rate about 40%. No etiological cause can be found in 50-80% of the cases.  Angioedema The lesions are deeper and the swelling much more. Angioedema may accompany urticaria or may occur independently. The face and the tissues of the oropharynx are sometimes affected by the angioedema, which can lead to life- threatening difficulties in swallowing and breathing. angioedema  Physical urticaria Cold urticaria : urticarial swelling of the hands, face and elsewhere may occur after exposure to the cold. Heat urticaria A very rare type of physical urticaria induced by direct contact of the skin with heat. Pressure urticaria : lesions develop some time (up to several hours) after pressure on the skin, for example from belts or other tight clothing, or from the rungs of a ladder. Dermographism.  Solar urticaria: Urticarial spots develop on exposed skin a few minutes after exposure to the sun. Various wavelengths may be responsible.  CHOLINERGIC URTICARIA Irritating, small urticarial spots develop after exercise or hot baths. This very common disorder can be very disabling in a few patients.  Papular Urticaria ❑ Encounter in old infants and children under 10 years old. ❑ Characterized by chronic or recurrent severely itchy round red papules grouped in irregular clusters. ❑ The commenst sites affected are the exposed parts. ❑ The etiology is hypersensitivity reaction to arthropod biting commonly fleas, mites, bedbugs and mosquitoes.  Idiopathic Urticaria The term idiopathic describes a disease or condition that is without known cause. Recent research has suggested that up to a half of patients with idiopathic urticaria have the condition because an auto-antibody is present.  Treatment Avoid physical triggers. Antihistamines of the H1 receptor blocker type are most effective at relieving symptoms in this disorder.  The ‘older’ or first generation antihistamines such as promethazine and diphenhydramine are quite effective, but have a hypnotic effect precluding driving or using machinery. Newer or second generation antihistamines such as foxfenadine, astemizole, cetirizine and loratidine are also effective, with less hypnotic effect.  A few patients obtain increased benefit by adding an H2 antagonist such as cimetidine. Acute severe urticaria and angioedema may require oral corticosteroids. Where the condition is life threatening, intravenous hydrocortisone should be used. Epinephrine ?? Anaphylactic shock