荨麻疹和血管神经性水肿(英文)课件.ppt

1、Introduction:Urticaria and AngioedemaUrticariaAngioedemaEtiology of Urticarial Reactions:Allergic TriggersAcute UrticariaDrugsFoodsFood additivesViral infections hepatitis A,B,C Epstein-Barr virusInsect bites and stingsContactants and inhalants (includes animal dander and latex)Chronic UrticarialPhy

2、sical factorscoldheatdermatographicpressuresolarlIdiopathicThe Pathogenesis of Chronic Urticaria:Cellular MediatorsHistamine as a Mast Cell MediatorRole of Mast Cells in Chronic Urticaria:Lower Threshold for Histamine ReleaseRelease threshold decreased by:Cytokines&chemokines in the cutaneous microe

3、nvironmentAntigen exposureHistamine-releasing factorAutoantibodyPsychological factorsRelease threshold increased by:lCorticosteroidslAntihistamineslCromolyn(in vitro)Cutaneous mass cellAn Autoimmune Basis for Chronic Idiopathic Urticaria:Antibodies to IgEInitial Workup of UrticariaPatient historySin

4、usitisArthritisThyroid diseaseCutaneous fungal infectionsUrinary tract symptomsUpper respiratory tract infection (particularly important in children)Travel history(parasitic infection)Sore throatEpstein-Barr virus,infectious mononucleosisInsect stingsFoodsRecent transfusions with blood products(hepa

5、titis)Recent initiation of drugsPhysical examlSkinlEyeslEarslThroatlLymph nodeslFeetlLungslJointslAbdomenLaboratory Assessment for Chronic UrticariaPossible tests for selected patientsStool examination for ova and parasitesBlood chemistry profileAntinuclear antibody titer(ANA)Hepatitis B and CSkin t

6、ests for IgE-mediated reactionsInitial testslCBC with differentiallErythrocyte sedimentation ratelUrinalysislRAST for specific IgElComplement studies:CH50lCryoproteinslThyroid microsomal antibodylAntithyroglobulinlThyroid stimulating hormone(TSH)HistopathologyGroup 2:Polymorphous perivascular infilt

7、rateNeutrophilsEosinophilsMononuclear cellsGroup 3:lSparse perivascular lymphocytesUrticaria Associated With Other ConditionsCollagen vascular disease(eg,systemic lupus erythematosus)Complement deficiency,viral infections(including hepatitis B and C),serum sickness,and allergic drug eruptionsChronic

8、 tinea pedisPruritic urticarial papules and plaques of pregnancy(PUPPP)Schnitzlers syndromeH1-Receptor Antagonists:Pros and Cons for Urticaria and AngioedemaFirst-generation antihistamines(diphenhydramine and hydroxyzine)Advantages:Rapid onset of action,relatively inexpensiveDisadvantages:Sedating,a

9、nticholinergicSecond-generation antihistamines(astemizole,cetirizine,fexofenadine,loratadine)Advantages:No sedation(except cetirizine);no adverse anticholinergic effects;bid and qd dosingDisadvantages:Prolongation of QT interval;ventricular tachycardia(astemizole only)in a patient subgroupFour-week

10、Treatment Period:Fexofenadine HClMean Pruritus Scores/Mean Number of Wheals/Mean Total Symptom ScoresAn Approach to the Treatment of Chronic UrticariaTreatment of Urticaria:Pharmacologic OptionsAntihistamines,othersFirst-generation H1Second-generation H1Antihistamine/decongestant combinationsTricycl

11、ic antidepressants (eg,doxepin)Combined H1 and H2 agentsBeta-adrenergic agonistsEpinephrine for acute urticaria (rapid but short-lived response)TerbutalineCorticosteroidslSevere acute urticariaavoid long-term useuse alternate-day regimen when possiblelAvoid in chronic urticaria (lowest dose plus ant

12、ihistamines might be necessary)MiscellaneouslPUVAlHydroxychloroquinelThyroxineAtopic Dermatitis:Acute,Subacute,and Chronic LesionsAcute Cutaneous LesionsErythematous,intensely pruritic papules and vesiclesConfined to areas of predilectioncheeks in infantsantecubitalpoplitealSubacute Cutaneous Lesion

13、sErythema excoriation,scalingBleeding and oozing lesionsChronic LesionsExcoriations with crustingThickened lichenified lesionsPostinflammatory hyperpigmentationNodular prurigoAtopic Dermatitis:Physical Distribution by Age GroupImmune Response in Atopic DermatitisMarkedly elevated serum IgE levelsPer

14、ipheral blood eosinophiliaHighly complex inflammatory responses IgE-dependent immediate hypersensitivityMultifunctional role of IgE(beyond mediation of specific mast cell or basophil degranulation)Cell types that express IgE on surfacemonocyte/macrophagesLangerhans cellsmast cellsbasophilsAtopic Der

15、matitis:Tests to Identify Specific TriggersSkin prick testing for specific environmental and/or food allergensRAST,ELISA,etc,to identify serum IgE directed to specific allergens in patients with extensive cutaneous involvementTzanck smear for herpes simplexKOH preparation for dermatophytosisGrams st

16、ain for bacterial infectionsCulture for antibiotic sensitivity for staphylococcal infection;supplement with bacterial culturesCultures to support tests bacterial,viral,or fungalTopical CorticosteroidsRanked from high to low potency in 7 classesGroup 1(most potent):betamethasone dipropionate 0.05%Gro

17、up 4(intermediate potency):hydrocortisone valerate 0.2%Group 7(least potent):hydrocortisone hydrochloride 1%Local side effects:Development of striae and atrophy of the skin,perioral dermatitis,rosacea Systemic effects:Depend on potency,site of application,occlusiveness,percentage of body covered,len

18、gth of useMay cause adrenal suppression in infants and small children if used long termAntihistamines and Other TreatmentsStandard TreatmentOral antihistamines to relieve itchingMoisturizer to minimize dry skin Topical corticosteroidsHard-to-manage DiseaseAntibioticsCoal tar preparations(antipruritic and anti-inflammatory)Wet dressings and occlusionSystemic corticosteroidsUV light therapyHospitalization