Fernando Vega, M.D. 1 Common Dermatological Common Dermatological Dilemmas Dilemmas Fernando Vega, M.D. Seattle Healing Arts Itchy Wheals Itchy Wheals Itchy Wheals Itchy Wheals • When is it Urticaria? • When is it angioedema? • When is it allergic? • When is it non-allergic? Urticaria Urticaria • Wheals, superficial • Pruritic • Transient • Pale center • Different initiators Angioedema • Deeper swelling • Poorly defined • May affect mucosa • Not Transient Dermatographism
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Fernando Vega, M.D. 1
Common Dermatological Common Dermatological DilemmasDilemmas
Fernando Vega, M.D.Seattle Healing Arts
Itchy WhealsItchy Wheals
Itchy WhealsItchy Wheals
• When is it Urticaria?• When is it angioedema?• When is it allergic?• When is it non-allergic?
UrticariaUrticaria
• Wheals, superficial• Pruritic• Transient• Pale center• Different initiators
Angioedema
• Deeper swelling• Poorly defined• May affect mucosa• Not Transient
Dermatographism
Fernando Vega, M.D. 2
Urticaria - Excercise Urticaria - Pressure
Urticaria - cold Urticaria - vasculitis
• Lasts longer• May bruise
Urticaria – Allergic contact Urticaria – non allergic
• Non immunological contact from Nettle stingNettle sting
Fernando Vega, M.D. 3
UrticariaUrticaria
• Idiopathic• Immunologic
– Autoimmune (auto antibodies against Fc RI or IGEIgE dependent (allergic)
– Exercise induced• Solar Urticaria• Aquagenic urticaria
Itchy RashesItchy Rashes
Atopic Dermatitis
• Chronic, relapsing, pruritic• Three stages:infantile, childhood, adulthood• Xerosis component with susceptibility to irritants
Synonym: Eczema
Xerosis component with susceptibility to irritants• Family history of atopy• Majority have occurences before 5 years of age• Disposition influenced by environment• Immunoabeerration: IgE, eosinophillia• Responsive to corticosteroids and macrolide
immuomodulators
Atopic DermatitisAtopic Dermatitis
• In infancy occurs more on face, extensor surfacessurfaces
Fernando Vega, M.D. 4
Atopic DermatitisAtopic Dermatitis
• On extensor surfaces of arms
Atopic DermatitisAtopic Dermatitis
• Severe chronic hand dermatitis in an adult
Atopic DermatitisAtopic Dermatitis
• Exaggerated palmar creases in icthyosis
Atopic DermatitisAtopic Dermatitis
• Keratosis pilaris
Atopic DermatitisAtopic Dermatitis
• Infected hand dermatitis
Complications
Atopic DermatitisAtopic DermatitisDiagnostic Features by AAD consensus
Essential features: must be present, and if complete are sufficient for diagnosis•Pruritus•Eczematous Changes
•Typical and age-specific patters•Face, neck and extensor involvement in infants and children•Current or piror flexural lesions at current or any agep y g•Sparing of groin and axiallry regions
•Chronic or relapsing courseImportant features: seen in most cases for support of the diagnosis
•Early age of onset•Atypical vascular responses•Xerosis
Associated features: help in suggesting the diagnosis•Perifollicular accentuation / lichenification / prurgo•Keratosis pilaris / ichthyosis vulgaris / palmar hyperlinearity•Ocular / Periorbital changes•Perioral / periauricular lesions
Fernando Vega, M.D. 5
Atopic DermatitisAtopic DermatitisDiagnostic Features
Major features (3 of 4 present)•Pruritius•Typical morphology and distribution•Chornic or chronically relapsing dermatitis•Personal or family history of atopy
Minor features (3 of 23 present)Minor features (3 of 23 present)•Xerosis•Ichthyosis/palmar hyperlinearity/keratosis pilaris•Type 1 skin reactivity•Elevated serrum IgE•Early age of onset•Tendency toward cutaneous infection/impaired cell-mediated immunity•Tendency towrds non-specific hand or foot dermatitis•Nipple eczema•Cheilitis•Recurrent conjuntivitis•Denne-Morgan intraorbital fold
Atopic DermatitisAtopic DermatitisDiagnostic Features
More Minor features (3 of 23 present)•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythema•Pityriasis alba•Anterior neck folds•Pruritus when sweating•Intolerance to wool and lipid solvents•Perifollicular accentuation•Food intolerance•Course influenced by environmental or emotional factors•White dermatographism / delayed blanch