Bright Red Rash

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Spectrum of Reactive Vascular Dermatoses

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DAMAGE TO DERMAL BLOOD VESSELS
Erythema
Uticaria
Erythema multiforme
Erythema nodosum
Vasculitis

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Generalized macular and papular eruptions

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Viral exanthems
Drug Eruptions
Other

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Annular erythemas

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- Erythema annulare centrifugum
- Erythema migrans (Lyme Dz)
- Erythema gyratum repens
- Erythema marginatum

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Uticaria

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hives (where individual hive will last for 24 hours)
-inflammatory reaction in the superficial dermis

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Angioedema

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-Reaction in the submucosa, deep dermis, and subcutaneous tissue

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Acute

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Less than 6 weeks duration

Chance of finding trigger = 75%

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Chronic

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More that 6 weeks duration

Chance of finding trigger = 1%
60% chance that you’ll have it in 10 years
Normally an autoimmune disease

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Uticaria Epidemiology

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Common: up to 15-20% of college students
Young adults
Atopic predisposition

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Uticaria Pathogenesis

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-Final common pathway involves mast cell degranulation and mediator release
-IgE-mediated
-Direct efforts on mast cells
-Complement (eg C5A) mediated release
-Facilitation of release by products of lipoxygenase pathway of arachidonic acid
-Autoimmunity

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Causes of Uticaria

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-Drugs
-Foods
- Inhalents
-Systemic Diseases
-Infections
-Physical Agents
-Insect Bites
-Non-Immunologic causes

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erythema

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blood vessels are dilated but nothing is leaking out. You can cause blanching b/c no red blood cells are coming out of the vessels when you push down

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Timeline from exposure to hypersensitivity eruption?

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up to 2 weeks

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serum sickness

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abnormal liver function test
eosinophilia
fever
an immune complex disease appearing some days (usually 1–2 weeks) after injection of a foreign serum or serum protein, with local and systemic reactions such as urticaria, fever, general lymphadenopathy, edema, arthritis, and occasionally albuminuria or severe nephritis; originally described in patients receiving serotherapy.

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Post-Erythema Desquamation

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peeling
results from when the skin was EXTREMELY red

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Urticaria
How do we classify appropriately?

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24 hour rule
circle lesions

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What drugs make Urticaria worse?

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NSAIDs

b/c 60% of people will get worse because they block the breakdown of AA in Cox pathway .: AA become leukotrienes instead of prostaglandins

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Atopic predisposition

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people who have a high predisposition to hives

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Urticarial reaction

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Blood vessel dilates and proteinaceous fluid leaks
Swelling in the dermis
Looks like an orange peel..no epidermal change (scale)

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Erythema Multiforme

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- look like targets
- purpura when you push b/c RBCs leak out
- makes a blister
an acute eruption of macules, papules, or subepidermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, including drug sensitivity, or it may be caused by herpes simplex infection; the eruption, although usually self-limited (e.g., multiforme minor), may be recurrent or may run a severe course, sometimes with fatal termination (e.g., multiforme major or Stevens-Johnson syndrome).

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Steven's Johnson Syndrome

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a bullous form of erythema multiforme that may be extensive, involving the mucous membranes and large areas of the body; it may produce serious subjective symptoms and may have a fatal termination

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Toxic epidermal necrolysis

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- a syndrome in which a large portion of the skin becomes intensely erythematous with epidermal necrosis and peels off in the manner of a second-degree burn, often simultaneous with the formation of flaccid bullae, resulting from drug sensitivity or of unknown cause; the level of separation is subepidermal, unlike staphylococcal scalded skin syndrome in which there is subcorneal change
(+) nikolsky sign

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Some Causes of EM/SJS/TEN

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-Drugs (bactrim)
-Infections
-Associated conditions – Pregnancy, Malignancy, Collagen vascular diseases, Inflammatory bowel disease
-Idiopathic

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Mortality with Toxic Epidermal Necrolysis

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30%

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What is the difference between Erythema Multiforme and Syphilus...they both have rash on hands...

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Erythema Multiforme have blisters

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Recurrent Erythema Multiforme is caused by

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HSV

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Causes of Toxic Epidermal Necrolysis or Steven's Johnson Syndrome

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Drugs

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Erythema Nodosum

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this is in the subcutaneous
looks like a bruise
blood vessels in the fat

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the most common drug to cause erythema nodosum

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birth control pills

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the most common infection to cause erythema nodosum

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strep
but in the world TB

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Photosensitivity from Drugs

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Griseofulvin
Nalidixic acid
Phenothiazines
Psoralens
Sulfonamides
Sulfonoureas
Tetracyclines
Thiazides
NSAIDS
(320-400 nm = safe waves.
This is really well absorbed by ringed molecules…photons of energy are released from cyclic rings and cause ROS)

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polymorphus light eruption

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true sun allergy
-worst in the spring time

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solar urticaria

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few minutes of sun=hives

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Photosensitivity Diseases

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Polymorphous Light Eruption
Solar Urticaria
Lupus Erythematous

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Treatment for TEN

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3 doses of IVIG on 3 consecutive days