How I Cured my Hives

Full Urticaria Cure

Natural Urticaria And Angioedema Treatment was created by Dr. Gary M Levin, who has many years of experience in studying hives treatments. The main manual of this treatment contains 191 pages that cover all necessary information about celiac disease, in general, and Urticaria and Angioedema, particular. The e-guide offers learners a step-by-step strategy on how to get rid of all symptoms o hives and Angioedema and the method to prevent their problem from coming back. Dr. Levins guide to curing urticaria treats the condition by addressing the root causeyour overactive immune system. Instead of having you avoid allergens (that you are not actually allergic to), or taking drugs that minimize the symptoms of your outbreaks, Dr. Levins methods will work to correct the issue in the immune system, thereby eradicating symptoms and preventing further outbreaks. Continue reading...

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Mast Cell Disease Urticaria Pigmentosa

Urticaria Pigmentosa Histopathology

Urticaria pigmentosa, telangiectasia macularis eruptive Cutaneous mast cell disease has several different manifestations. It can present during the neonatal period or throughout life. Different age populations generally develop different clinical manifestations and different associated conditions. It is the systemic form of mastocy-tosis in adults that has the most potentially severe complications. It has been estimated that from 15 to 50 of patients with adult-onset mast cell disease will have systemic involvement (1,2). However, for the sake of completeness, the other variants of this disease spectrum will also be considered. Urticaria pigmentosa is the global term for all conditions that are characterized by increased numbers of mast cells within the dermis. There is no gender predilection. Adults with mast cell disease are more likely to present with a widely scattered macular eruption. Individual lesions are often red-brown or hyperpigmented. The lesions are randomly distributed...

Nonimmunological Contact Urticaria

Nonimmunological contact urticaria (NICU) is the most common form and occurs without previous exposure in most individuals. The reaction remains localized and does not cause systemic symptoms to spread to become generalized urticaria. Typically, the strength of this type of contact urticaria reaction varies from erythema to a generalized urticarial response, depending on the concentration, skin site, and substance. The mechanism of nonimmunological contact urti- caria has not been delineated, but a direct influence on dermal vessel walls or a nonantibody-mediated release of histamine, prostaglandins, leukotrienes, sub- ja stance P, other inflammatory mediators, or different combinations of these media- tors represents possible mechanisms (56). The most potent and best studied sub- 4 stances producing nonimmunological contact urticaria are benzoic acid, cinnamic

Angioedema and Urticaria

Angioedema Pictures Eyelids

INTRODUCTION Angioedema and urticaria are common transient phenomena that result from mast cell degranulation with the release of mediators that promote vascular permeability, causing proteins and fluids to extravasate into the extracellular space. In urticaria fluid collects within the dermal tissue, whereas in angioedema fluid collects in the deeper subcutaneous space. The causes of mast cell degranulation are varied and include both immunologic and nonimmunologic mechanisms. Systemic involvement may include rhinitis, bronchospasm, or anaphylaxis. Severe reactions may lead to syncope, bronchial asthma, and hypotension. In rare cases both urticaria and angioedema may be triggered by exercise. Acute cases reach a peak in one to three days and usually fade in 7-21 days. In chronic cases the condition waxes and wanes for months or may even persist for years. There may be recurrent attacks separated by months to years. Inciting allergens are numerous and include foods, cosmetics,...

Mechanisms Of Contact Urticaria

CUS can be described in two broad categories nonimmunological contact urticaria (NICU) and immunological contact urticaria (ICU). The former does not require presensitization of the patient's immune system to an allergen, whereas the latter does. There are, however, contact urticaria reactions of unknown mechanism, and these are unclassified. Nonimmunological Contact Urticaria s Supporting this, Morrow et al. (8) demonstrated an increase in plasma PGD2 following the topical application of 1 sorbic acid to the human forearm. The time course of PGD2 peaks correlated temporally with the observed intensity of cutaneous vasodilatation. Notably, histamine and PGE2 levels at peak erythema were not significantly higher than pretreatment levels. This suggests that the release of vasodilatory prostaglandins induced by sorbic acid was selective for PGD2, and that histamine is not involved in sorbic acid contact urticarial reactions. The release of PGD2 was a dose-dependent effect, increasing...

Contact Urticaria Syndrome

Contact urticaria syndrome (CUS) has been defined as a wheal-and-flare response that develops within 30 to 60 min after exposure of the skin to certain agents (52,53). Symptoms of immediate contact reactions can be classified according to their morphology and severity Local wheal and flare with tingling and itching represents the prototype reaction of contact urticaria. Generalized urticaria after local contact is rare, but can occur from strong urticaria. Symptoms in other organs can appear with the skin symptoms in cases of immunological contact urticaria syndrome. The strength of the reactions may vary greatly and often the whole range of local symptoms can be seen from the same substance if different concentrations are used (54). In addition, a certain concentration of contact urticant may produce strong edema and erythema reactions on the skin of the upper back and face but only erythema on the volar surfaces of the lower arms or legs. In some cases, contact urticaria can be...

Immunological Contact Urticaria

Immunological contact urticaria (ICU) is an immediate type 1 allergic reaction (52). The molecules of a contact urticant react with specific IgE molecules attached to mast-cell membranes. The cutaneous symptoms are elicited by vaso-active substances, mainly histamine, released from mast cells. Other mediators of inflammation may influence the degree of response. Immunological contact urticaria reaction can extend beyond the contact site and generalized urticaria may be accompanied by other symptoms, such as rhinitis, conjunctivitis, asthma, and even anaphylactic shock. The term ''contact urticaria syndrome'' was therefore suggested by Maibach and Johnson (55). Fortunately, the appearance of systemic symptoms is rare, but it may be seen in cases of strong hypersensitivity or in a widespread exposure and abundant percutaneous absorption of an allergen.

Evaluation of Eyelid Lesions

Fluid Filled Cyst Eyelid

Configuration represents the shape of the lesion as it is seen from above. Common types of configurations include nummular (coin sized and shaped), gyrate, annular (ring-like border with some degree of clearing in the center), and linear lesions. Most lesions have a circular configuration. A few lesions are oval, notably those of pityriasis rosea, and many others are irregular in shape. Examples of irregular shapes include gyrate and serpigenous lesions, which generally occur due to the melding of adjacent lesions that are enlarging in a centrifugal manner until they reach the point of confluence. Such lesions are frequently found, for example in psoriasis and urticaria. On the other hand, irregular lesions with angular or linear shapes generally occur as a result of external trauma such as scratching or are due to the direct inoculation of antigen (ocular medications) or virus (linear warts). Linear lesions (the shape, not the arrangement of a group of lesions) are special types that...

Eyelid Lesions and Tissues of Origin

Microcystic Adnexal Carcinoma

The dermis is composed largely of collagen with a small amount of elastin. Few lesions arise directly from these materials, but the dermis is frequently involved with infiltrative and other processes (Fig. 2). In angioedema the dermis is edematous with an inflammatory cell infiltrate. White blood cell infiltration also predominates in blepharitis, cellulitis, insect bites, and in cicatricial phemphigoid. Leukemic infiltrates also accumulate within the dermal stroma.

Micronutrients 1231 Vitamins

Daily intakes of the antioxidant vitamin C (L-ascorbic acid) up to 1 g did not lead to toxic effects. The harmless use of vitamin C is also shown by Figure 12.2. There is a relatively wide margin between the RDA and the toxic dose. If high doses were taken over a long period of time, however, vitamin C appeared to induce toxic effects. Well-known adverse effects after doses as high as 1 g or more are gastrointestinal disturbances such as diarrhea, nausea, and abdominal cramps. Increased peristalsis, resulting from a direct osmotic effect on the intestine, is believed to be the cause. Occasionally, these effects are attributed to sensitization associated with urticaria, edema, and skin rashes. Toxic effects following high doses of vitamin C usually disappear within one or two weeks. They can be prevented by using buffered solutions of vitamin C or by intake after meals.

Scombroid Fish Poisoning

Symptoms Sudden warm facial flushing and sunburn-like rash, metallic-peppery taste, perioral burning and blistering sensations then urticaria, pruritus, bronchospasm, palpitations, tachycardia, hypotension fewer gastrointestinal symptoms of abdominal cramps, nausea, vomiting, and diarrhea. gas chromatography mass spectrometry, high serum and urine histamine and saurine levels. Treatment Severe poisoning gastric emptying, then AC gut decontamination otherwise, Hj-and H2-blockers, P-agonists for bronchospasm with wheezing, and consider corticosteroids for allergic bronchospasm and urticaria pruritus. Prognosis Symptoms resolve in 12-24 hours even without treatment.

Background Information

Most complement deficiencies result from abnormal function of the gene for the component in question, so that no protein is produced or secreted and the diagnosis of deficiency is relatively easy. There are also cases where dysfunctional proteins are made. This is true of C1-INH 15 of individuals with the hereditary form of C1-INH deficiency have normal or elevated levels of the protein, but insufficient function to protect them from angioedema.

Elevated Eosinophil and Basophil Counts

Reactive Bronchial Cells

Bacterial and viral infections are both unlikely ever to lead to eosinophilia except in a few patients with scarlet fever, mononucleosis, or infectious lymphocytosis. The second most common group of causes of eosinophilia are allergic conditions these include asthma, hay fever, and various dermatoses (urticaria, psoriasis). This second group also includes drug-induced hypersensitivity with its almost infinitely multifarious triggers, among which various antibiotics, gold preparations, hydantoin derivatives, phenothiazines, and dextrans appear to be the most prevalent. Eosinophilia is also seen in autoimmune diseases, especially in scleroderma and panarteritis. All neoplasias can lead to paraneoplastic eosinophilia, and in Hodgkin's disease it appears to play a special role in the pathology, although it is nevertheless not always present. Diffuse brownish papules, with urticaria on irritation Urticaria pigmentosa

Guinea Pig Ear Swelling Test

Predictive assays for evaluating the ability of materials to produce nonimmuno-logical contact urticaria have been developed. Lahti and Maibach (57) developed an assay in guinea pigs using materials known to produce urticaria in humans. One-tenth of a milliliter of the material (or control solvent) is applied to one ear of the animal. Ear thickness is measured before application and then every 15 min for 1 or 2 h after application. The maximum response is a 100 increase in ear thickness (within 50 min after application). Materials can also be screened for nonimmunological contact urticaria in humans. A small amount of the test material is applied to a marked site on the forehead and the vehicle is applied to a parallel site. The areas are evaluated at about 20 to 39 min after application for erythema and or edema (52). Differentiation between nonspecific irritant reactions and contact urticaria may be difficult. Strong irritants (e.g., hydrochloric acid, lactic acid, and phenol),

Informed Consent and Explanation of Blood Options

(1) There is a need to discuss the risks, benefits, and alternatives to blood transfusion and to ensure and that the potential recipient or his her representative has an opportunity to ask questions. The rationale for this arises for two reasons (a) there are real risks associated with blood transfusion. These are the risks of immediate death, which can occur with acute hemolytic reactions, acute bacterial infections or rarely anaphylactic reactions. Such real risks are now extremely uncommon, with a frequency of occurrence of less than 1 50,000, and death resulting, in probably less than 1 500,000. There are other risks associated with transfusion, such as minor allergic and febrile reactions, but these result mainly in patient discomfort and short-term morbidity (Chapter 32). These events are more frequent, and, with platelets, may occur in 3-20 of transfusions. The overall frequency is approximately 1 . The likely transmission of any viral disease causing significant morbidity...

Clinical manifestation

Most common in children, who have 25100 red-brown macules or barely elevated papules, usually over the trunk lesion becomes a wheal when rubbed (Darier's sign) solitary mastocytoma usually appears within first month of life rubbery, yellow to brown, plaques, urticate with or without vesiculation after rubbing (bullous urticaria pigmentosa) telangiectasia macu-laris eruptiva perstans brown macules and telangiectasias with erythema, often over upper trunk associated with peptic ulcer disease diffuse mastocytosis bullae in infancy, replaced by doughy skin, with generalized pruritus dermatographism, bullae after minor skin trauma mast cell infiltration of liver, spleen, skeleton, and gastrointestinal tract flushing syndrome, most common in early life

Infectious Mononucleosis

Infectious Mononucleosis Film

A white membrane covering one or both tonsils is characteristic and helpful in diagnosis. Hypersensitivity to ampicillin is increased in infectious mononucleosis, and the antibiotic should be avoided as a severe urticaria follows its use. The positive Paul-Bunnell blood test is diagnostic of infections mononucleosis, and atypical mononuclear white cells are increased on the blood film.

Clinical Assessment And Quantitative Methods

Previously, dermatological studies of the skin have scored the degree of urticaria by means of visual assessment by an experienced observer, usually a dermatologist. There are several advantages and disadvantages to this technique. Advantages are that it is inexpensive, visual scoring is rapid, subjects are regularly assessed so that the study can be curtailed if adverse reactions are severe, and unexpected findings can be handled by the investigator. However, simple observation may introduce error, inter- and intraobserver variation. This is especially important in larger studies, which may involve a team of investigators. Visual Scoring of Contact Urticaria Contact urticaria can be graded visually by marking the degree of erythema and edema on an ordinal scale. Tables 2 and 3 provide examples.

Clinical Features

Extracutaneous involvement may occur in visceral organs, lymph nodes, soft tissue, and skeletal muscles. Eye involvement occurs in up to 10 of cases and may lead to secondary glaucoma due to hemorrhage into the anterior chamber (1-3). The association of JXG with neurofibromatosis I and chronic juvenile myelogenous leukemia is well-established. Many other perhaps coincidence associations have also been reported such as with Niemann-Pick disease and urticaria pigmentosa (4-6).

Allergies to Medications

As harmful and begins producing antibodies to fight it. Finally, the person takes another dose of the drug, and the allergy symptoms appear. The symptoms may appear immediately, within 1 to 2 hours, or within a few days to a week after taking the drug. Common symptoms of drug allergy include skin rash or hives, difficulty breathing, and itching. Severe drug allergies may cause seizures, loss of consciousness, or shock (see box below). If you have had a previous severe allergic reaction, you will need to carry an injecting device that contains epinephrine with you at all times, so you can inject yourself immediately if you have another allergic reaction. An injection of epinephrine can save your life. During an anaphylactic reaction, the body releases massive amounts of histamine and other powerful chemicals in response to the presence of the allergen. The blood vessels widen, causing a sudden, severe decrease in blood pressure. Other symptoms can include hives (itchy, raised, red...

Prognosis of Rare Variants of Cutaneous Lupus Erythematosus

LE tumidus (LET) is a subtype of CLE with some peculiarities. Clinically, LET is characterized by erythematous, succulent, urticaria-like, nonscarring plaques with a smooth surface in sun-exposed areas. Reproduction of skin lesions after UVA or UVB irradiation is possible in 70 of the cases. The sex ratio shows an equal distribution between males and females. Nonspecific LE skin lesions are uncommon, and, usually, none of the patients can be classified as SLE, reflecting that LET is a CLE variant with a more benign course (Kuhn et al. 2000) (Table 14.3).

Vasopeptidase Inhibitors

Vasopeptidase inhibitors are drugs that are capable of simultaneously inhibiting ACE and the neutral endopeptidase (NEP, also known as EC 24.11). NEP is a cell surface metalloprotease that degrades various bioactive peptides, including big endothelin-1. Inhibition of NEP is anticipated to reduce the formation of endothelin-1 from big endothelin-1. None of the vasopeptidase inhibitors are currently marketed in the US. The first dual inhibitors, thiazepinones and oxazepinones, were synthesized at Bristol-Myers Squibb. In 1998 Trippodo et al. described the antihypertensive activity of the lead compound from this series, omapatrilat (see Figure 4).43 Omapatrilat lowered arterial pressure in normal and high renin models of hypertension, prevented vascular remodeling, and provided long-term renoprotection to rats. In the initial clinical studies omapatrilat appeared to be highly promising, but a subsequent large clinical trial found that the rate of angioedema with omapatrilat was three...

Appendix A Table of Primary Lesions and Related Disorders

Tinea (large, multiloculated) Part III Urticaria (bullae as secondary lesions) Part III Macules Malignant melanoma Part V Molluscum (tightly-grouped papules) Part II Pityriasis rosea (rosy red) Part II Psoriasis Part II SCLE (sharply defined) Part IV Seborrheic keratosis Part V SLE (edematous) Part IV Squamous cell carcinoma (indurated) Part V Tinea (indurated) Part III Toxicodendron dermatitis (linear) Part IV Urticaria (edematous) Part III Pustules

Cinnamic Aldehyde Cinnamaldehyde 3Phenyl2Propenal CAS Registry Number [104552

This perfumed molecule is used as a fragrance in perfumes, a flavoring agent in soft drinks, ice creams, dentifrices, pastries, chewing-gum, etc. It can induce both contact urticaria and de-layed-type reactions. It can be responsible for dermatitis in the perfume industry or in food handlers. Cinnamic aldehyde is contained in fragrance mix. As a fragrance allergen, it has to be mentioned by name in cosmetics within the EU. Nethercott JR, Holness DL (1989) Occupational dermatitis in food handlers and bakers. J Am Acad Dermatol 21 485-490 Seite-Bellezza D, El Sayed F, Bazex J (1994) Contact urticaria from cinna-mic aldehyde and benzaldehyde in a confectioner. Contact Dermatitis

DihydroxyN3Hydroxypropyl33Dimethylbutanamide Pantothenylol NPantoyl3Propanolamine Panthenol Pantothenyl Alcohol

Pan(to)thenol is the alcohol corresponding to pantothenic acid, of the vitamin B5 group. It is used as a food additive, and in skin and hair products as a conditioning agent. Contact dermatitis and urticaria have been reported. Schalock PC, Storrs FJ, Morrison L (2000) Contact urticaria from panthe-

Psoriasis and Lupus Erythematosus

The control of SLE often requires systemic administration of steroids, especially for renal and central nervous system involvement. A rebound flare of psoriasis is always possible on withdrawal of steroid therapy. Administration of antimetabolites used as steroid-sparing agents may prevent this rebound flare and improve psoriasis. Phototherapy is contraindicated in patients with cutaneous LE. On the contrary, pso-ralen-UVA exposure is indicated in psoriatic individuals and in those with severe photosensitive psoriasis. Screening for ANAs, including anti-Ro SSA and anti-La SSB antibodies, is necessary before treating any photosensitive patient with UV light. Psoriasis could coexist with other photosensitive disorders, such as vitiligo, por-phyria, drug-induced photodermatitis, polymorphous light eruption, chronic actinic dermatitis, solar urticaria, actinic prurigo, and the so-called fair skin type .

Clinical Photosensitivity in Lupus Erythematosus

Provocative Phototesting

And solar urticaria Physical examination may reveal a distribution suggestive of a photosensitive condition in the absence of a history of photosensitivity. The most common areas for skin lesions in LE include sun-exposed areas such as the face, the V-area and posterior aspect of the neck, the ears, the dorsa of the hands, and the forearms. Equally helpful may be areas that are specifically spared from sun exposure, including the upper eyelids, submental areas, finger web spaces, and general creases within skin folds, where a photosensitive eruption is noticeably absent. Furthermore, investigation of patients with photosensitivity includes routine tests to establish the diagnosis and extent of disease activity, including hematology, biochemistry, serology, and complement studies. Skin biopsies and immunofluorescence may also be appropriate. Provocative photo-testing is an objective means of demonstrating whether a patient has an abnormal response to UV exposure however, phototesting...

Gender Ethnicracial And Life Span Considerations

Approximately one to two out of four patients with allergic purpura have GU symptoms such as dysuria and hematuria. Other symptoms include headaches fever peripheral edema and skin lesions accompanied by pruritus, paresthesia, and angioedema (swelling of the skin, mucous membranes, or organs). Other patients describe severe GI symptoms (spasm, colic, constipation, bloody vomitus, bloody stools) and joint pain. PHYSICAL EXAMINATION. Inspect the patient's skin for the typical skin lesions patches of purple macular lesions of various sizes that result from vascular leakage into the skin and mucous membranes. These lesions most commonly occur on the hands and arms. Note that, in children, the lesions more commonly start as urticarial areas that then expand into hemorrhagic lesions. Determine if the patient has any peripheral swelling, particularly in the hands and face. Perform gentle range of motion of the extremities to determine the presence and location ofjoint pain. Assess...

Epidemiology of the Cutaneous Manifestations of Lupus Erythematosus

ACLE appears in 30 -60 of patients with SLE. It includes localized (malar) erythema, widespread (face, scalp, neck, upper chest, shoulders, extensor arms, and back of hands) erythema, and bullous (toxic epidermal necrolysis-like) LE. Additionally, nonspecific but disease-related cutaneous manifestations can appear in patients with LE, including photosensitivity, alopecia, urticaria, livedo reticularis, dermal vasculi-tis, and Raynaud's phenomenon (Yell et al. 1996). Urticaria ( ) Urticaria, angioedema, and Raynaud's phenomenon are common cutaneous vascular reaction patterns. Some patients with SLE described lesions suggestive of urticarial vasculitis, with prevalences ranging from 7 (Provost et al. 1980) to 22 (O'Loughlin et al. 1978). Dermal vasculitis has been reported in 18 to 70 of patients with SLE. Livedo reticularis maybe associated with the antiphospholipd syndrome and has been reported as an initial manifestation of SLE in many patients (Weinstein et al. 1987a). Other skin...

Primary Nursing Diagnosis

Typing, screening, and matching of blood units before administration eliminates most incompatibilities, but not all of them. If a transfusion reaction does occur, stop the transfusion immediately. The severity of the reaction is usually related to the amount of blood received. Begin an assessment to determine the severity and type of reaction. In minor reactions (urticaria or fever), the transfusion may be restarted after discussion with the physician and after giving the patient an antipyretic, antihistamine, or anti-inflammatory agent. Ongoing monitoring during the rest of the transfusion is essential. If the patient develops anaphylaxis, the patient's airway and breathing are maintained with oxygen supplement, intubation, and mechanical ventilation if needed.

Adverse Reactions and Warnings

The most serious adverse event reported subsequent to Activase administration is bleeding. If serious intracranial, gastrointestinal, retroperitoneal, or pericardial bleeding occurs, treatment must be immediately discontinued. Allergic reactions, including anaphylactoid reactions, laryngeal edema, and urticaria have also been reported. The product should be used with extreme caution in pregnant women, for whom there are no well-controlled studies. Activase has an embryocidal effect in rabbits when administered in doses of twice the level used to treat AMI in humans. Caution should also be exercised with nursing mothers as it is not known if Activase is excreted into human milk. Negative results were recorded when the product was subjected to a mutagenicity test (the Ames test), chromosomal aberration assays in human lymphocytes, and short-term tumorigenicity studies. Long-term studies in animals to evaluate carcinogenic potential or effect on fertility have not been undertaken.

Clinical Application Questions

A 48-year-old woman is seen for intensely pruritic raised lesions on her trunk and extremities of 3 weeks' duration. Clinically her lesions look to you like hives. 2. Would this most likely be classified as acute urticaria, chronic urticaria, or chronic intermittent urticaria, and why 3. Assuming this is acute urticaria, what history should be sought to establish a possible cause 4. Assuming this is acute urticaria, what laboratory studies are indicated 6. What is the prognosis for acute urticaria

Dermatologic Physical Exam

Edematous plaques wheals or hives (see Photos 20-22). These raised plaques have sharp margins and the central color can vary from pink to yellow to white. A peau d'orange effect may be present in the center and there is often a peripheral dusky blotchy red border, which is the axon reflex. Individual hives may vary from a few millimeters to greater than palm-sized. Hives may remain discrete or may become confluent, forming geometric and polycyclic shapes. Pruritus is usually severe, especially at onset, and the lesions usually evolve rapidly, then resolve within a few hours. Although they are usually primary lesions, rarely bullae may develop as secondary lesions on the hive surface when edema is rapid and severe. Also very rarely purpura may occur in hives with marked vasodilation.

Indicated Supporting Diagnostic Data

Case history is critical to the discovery of a specific cause in acute, intermittent, or chronic urticaria. Testing should be guided by historical data, and extensive blind testing is seldom productive. History should be repeated periodically, as the victim may recall forgotten information or, over time, may make new associations. Biopsy is seldom indicated for urticaria when a question arises regarding common hives versus urticarial vasculitis (see Differential Diagnosis section), biopsy will help to distinguish them. This should be done in a staged fashion, eliminating first any suspect allergens and any substances known to cause pseudoallergic hives or nonspecific histamine or mediator release. With severe symptoms or with chronic disease, an avoidance diet with staged reintroduction of different food groups may be useful. In chronic urticaria, sinus films and apical dental films have the highest yield. They may be positive even when symptoms are absent. Other X-rays should be...

Prognosis of Cutaneous Lupus Erythematosus

Classic variants of specific CLE lesions are DLE and SCLE. Other typical CLE subsets, such as LE profundus panniculitis, LE tumidus, urticaria vasculitis, hypertrophic LE, and bullous LE, are rather rare variants. Butterfly rash and macular exanthema are characteristic skin lesions of SLE rarely found in patients with CLE. DLE and SCLE may appear at any age, but the most common age at onset is 20-40 years in females and males, with a female predominance of 3 1 in DLE and 3 1 to 6 1 in SCLE. Nonspecific LE skin lesions such as generalized or acrolocalized vasculitis (4 -30 ), livedo reticularis (22 -35 ), and alopecia (38 -78 ) are frequently seen in patients with CLE (Beutner et al. 1991,Callen 1985,1986,Molad 1987,Moschella 1989, Sontheimer 1979, Tebbe and Orfanos 1992).

Pregnancy Category B vaginal

Special Concerns Use with caution in infants up to 1 month of age, in clients with GI disease, liver or renal disease, or a history of allergy or asthma. Safety and efficacy of topical products have not been established in children less than 12 years of age. Side Effects Oral Candidiasis. GI N&V, diarrhea, bloody diarrhea, abdominal pain, GI disturbances, te-nesmus, flatulence, bloating, anorexia, weight loss, esophagitis. Nonspecific colitis, pseudomembranous colitis (may be severe). Allergic Morbilliform rash (most common). Also, maculopapular rash, urticaria, pruritus, fever, hypotension. Rarely, polyarteritis, anaphylaxis, erythema multiforme. Hematologic Leukope-nia, neutropenia, eosinophilia, thrombocytopenia, agranulocytosis. Miscellaneous Superinfection. Also sore throat, fatigue, urinary frequency, headache. Following vaginal use Cervicitis, vaginitis, vulvar irritation, urticaria, rash.


Among the wide-ranging environmental factors affecting human life, ultraviolet (UV) irradiation can be regarded as one of the most significant. Although UV light has an essential impact on terrestrial and aquatic ecology and is a fundamental necessity for the life of humans, animals, and plants, mid-wavelength UVB (290-320 nm) in particular can also exert hazardous effects on health. UV radiation not only plays an instrumental role in the development of skin cancer but also has profound effects on local and systemic inflammatory responses. While studying the biological effects of UVB irradiation, it has become evident that UV exposure can significantly compromise the immune system. The implications of the immunosuppres-sive properties of UV irradiation are manifold because UVB-induced immunosup-pression not only is responsible for the inhibition of protective cell-mediated immunity but also contributes to the initiation, development, and perpetuation of several skin disorders (Fisher...

Specific History

The name pityriasis rosea is descriptive and refers to the rosy-red color of early lesions and the fine branny scale that evolves in the later phase. All PR lesions evolve in a similar way. The earliest lesions, especially the herald plaque, tend to be larger than the later ones (3-4 cm vs 1-2 cm). Early lesions and the herald plaque are usually out of phase with the smaller secondary lesions, and their more advanced morphology aids in the diagnosis. A typical lesion runs its course over a 3- to 4-week period. At onset, lesions start as bright rosy-red papules or plaques that resemble wheals of urticaria. As each lesion approaches its full size, the center darkens and a fine scale occurs. When the central scale loosens, a collarette of white scale is left at the periphery with its free edge characteristically turned toward the center of the lesion. Next the color changes to a dull salmon-pink, the plaque flattens, scales develop over its entire surface, and it disappears. 3. An active...

Bullous pemphigoid

Tense vesicles and bullae, with a predilection for the flexor areas of the skin oral and ocular mucosa involvement seldom occurs bullae clinically either inflammatory or non-inflammatory blisters usually heal without scarring or milia formation localized form with blisters confined to the extremities lesions sometimes urticarial without vesiculation Cicatricial pemphigoid herpes gestationis linear IgA bullous dermatosis dermatitis herpetiformis chronic bullous dermatosis of childhood dyshidrosis bullous lupus erythematosus pemphigus vegetans urticaria

The Hapten Concept

Low-molecular-weight chemicals (commonly with a molecular mass of less than 1000 Da) are not recognizable by T cells. However, if they are reactive and capable of binding to proteins they may become part of presented peptides (Figure 3) as so-called haptens. In particular electrophilic properties of a chemical will enable it to react with nucleophilic groups of proteins such as the thiol group in cysteins (-SH), amino group of lysine (-NH2) or the hydroxy (-OH) group of tyrosine.22 Known reactive chemicals are isocyanates, quinones, aldehydes, epoxides, beta lactams, and certain nitroaromatics. If a chemical is very reactive, the immune reactions will take place at the site of first contact, e.g., the skin or the lung. Formation of novel antigens recognizable by T cells ('neoantigens') has been shown using the classical hapten trinitrophenol,23 the sensitizing compound of poison ivy, 3-pentadecyl-catechol (urushiol),24 or penicillin.25 Penicillin-induced allergies have been...

Pruritus Itch

Periungual Pigmentation Nail

Contact dermatitis (axillae, waistline), erythrasma (axillae), pediculosis corporis, psoriasis, scabies, seborrheic dermatitis (chest), seborrheic keratoses, urticaria Contact dermatitis dermatitis herpetiformis eczema atopic, nummular, bullous pemphigoid, mycosis fungoides, psoriasis, PUPPP, urticaria, xerosis


The most serious complication of hepatitis is fulminant hepatitis, which occurs in approximately 1 of all patients and leads to liver failure and hepatic encephalopathy and, in some, to death within 2 weeks of onset. Other complications include a syndrome that resembles serum sickness (muscle and joint pain, rash, angioedema), as well as cirrhosis, pancreatitis, myocarditis, aplastic anemia, or peripheral neuropathy.

Erythromycin base

Special Concerns Use of other drugs for acne may result in a cumulative irritant effect. Additional Side Effects When used topically Erythema, desquamation, burning sensation, eye irritation, tenderness, dryness, pruritus, oily skin, generalized urticaria. Drug Interactions Antagonism has been observed when topical eryth-romycin is used with clindamycin. How Supplied Enteric coated capsule 250 mg Enteric coated tablet 250 mg, 333 mg, 500 mg Gel Jelly 2 Ointment 2 Ophthalmic ointment 5 mg g Pad 2 Solution 1.5 , 2 Swab 2 Tablet 250 mg, 500 mg Tablet, Coated particles 333 mg, 500 mg


Chlorhexidine gluconate, a cationic bisbiguanide, was developed in England in the early 1950s and was introduced into the United States in the 1970s. It is a chlorophenol biguanide with a broad antimicrobial spectrum. It is thought that chlorhexidine produces enzymatic reactions within the cell that result in protein denaturation and inactivation of nucleic acids 16 . Chlorhexidine is active against many Gram-positive and to a slightly lesser degree Gram-negative bacteria. Chlorhexidine is supplied in various concentrations of 0.5 with 70 alcohol, 2 , and a 4 detergent. It has greater residual activity than alcohol alone and is not inactivated by the presence of blood or human protein 19, 38-40 . There is minimal absorption through the skin. Anaphylactic reactions with bronchospasms and generalized urticaria are very rare and are associated with use on mucous membranes. In a prospective, randomized trial by Fuchs et al. 41 , three different methods of catheter exit site care were...


Tartrazine is a yellow synthetic azo dye. Several clinical symptoms have been attributed to tartrazine, including asthma, hyperactivity of children, and urticaria (hives). With regard to hyperactivity of children, there is a controversy regarding the association between tartrazine and the hyperactivity. So far, studies on this potential problem have not provided conclusive evidence for such an association. A similar controversy links a possible association between tartrazine and urticaria. In this case too, no relationship has been found.


Type I (anaphylactic) due to preformed IgE antibodies, which cause release of vasoactive amines (e.g., histamine, leukotrienes) from mast cells and basophils. Examples are anaphylaxis (bee stings, food allergy especially peanuts and shellfish , medications especially penicillin and sulfa drugs , rubber glove allergy), atopy, hay fever, urticaria, allergic rhinitis, and some forms of asthma.


Anemia, leukopenia, thrombocy-topenia. Pulmonary Bronchopul-monary dysplasia with interstitial pulmonary fibrosis. Ophthalmologic Cataracts after prolonged use. Der-matologic Hyperpigmentation, especially in clients with a dark complexion also, urticaria, erythema multiforme, erythema nodosum, alopecia, porphyria cutanea tarda, excessive dryness and fragility of the skin with anhidrosis, dryness of the oral mucous membranes, cheilosis. Metabolic Syndrome resembling adrenal insufficiency, including symptoms of weakness, severe fatigue, weight loss, anorexia, N&V, and melanoderma (especially after prolonged use). Also, hyperuricemia and hyperuricosuria in clients with chronic myelogenous leukemia. Oral Dry mouth, stomatitis, cheilosis. Miscellaneous Cellular dysplasia in various organs, including lymph nodes, pancreas, thyroid, adrenal glands, bone marrow, and liver. Also, gynecomastia, seizures after high doses, cataracts after prolonged use, hepatotoxicity, cholestatic jaundice,...

Leukemia Cutis

Leukemia Monocytic

CLINICAL PRESENTATION Leukemia cutis of the eyelid skin manifests most commonly as multiple 1 to 2.5 cm discrete nodules ranging from a solitary lesion to involvement of 70 of the body surface. These lesions rarely ulcerate, and may be associated with urticaria and pruritis. Lesions vary in color from blue to red, to purple to green, to brown, depending on the amount of myeloperoxidase present within the immature blast cells. Diffuse infiltration of the dermis by leukemic cells may be seen. Associated ocular involvement may include lesions of the retina, optic nerve, globe, or conjunctiva. The retina shows the most frequent clinical involvement in leukemia with hemorrhage, cotton-wool spots, venous dilatation, micro-aneurysms, and leukemic infiltrates. Associated orbital disease is not uncommon and presents with pain, lid edema, and exophthalmos. Systemic manifestations include purpura due to thrombocytopenia, urticaria, pruritis, erythema multiforme, leonine facies, alopecia,...

Lupus Erythematosus

Keratoconjunctivitis Sicca Lupus

Common nonscarring eyelid lesions include a pruritic eruption of the lower eyelids. Scarring lesions often present as sharply demarcated purple-red, slightly raised, circumscribed plaques covered with thin adherent whitish scales and telangiectasias. Often such lesions are localized to the lateral aspect of the lower eyelids. Such lesions may enlarge to reach a size of about 5 to 10 mm. The major disfigurement of discoid lupus occurs as the lesions involute where atrophic scarring may lead to trichiasis and entropion. Often, pronounced hypopigmentation or hyper-pigmentation occurs. Other common skin manifestations include the classic butterfly rash, cutaneous vasculitic foci, urticaria, vesiculobullous lesions, and nonscarring alopecia. Ocular manifestations include retinal hemorrhages, cotton wool spots, retinal vasculitis, papillitis, diffuse retinal edema, keratoconjunctivitis sicca, and band keratopathy. Associated systemic findings in lupus erythematosus include arthralgia,...

Erythema multiforme

Erythema Exudativum

Stevens-Johnson syndrome toxic epidermal necrolysis Henoch-Schonlein purpura urticaria viral exanthem Kawasaki disease figurate erythema fixed drug eruption lupus erythematosus primary her-petic gingivostomatitis Behcet's disease aphthous stomatitis Most commonly associated with herpes simplex virus infection also associated with other infections, drug ingestion, rheumatic diseases, vasculitides, non-Hodgkin's lymphoma, leukemia, multiple myeloma, myeloid metaplasia, polycythemia Erythema multiforme minor variant occasional mild flu-like prodrome initial lesion dull red macule or urticarial plaque in the center, with small papule, vesicle, or bulla sometimes developing raised, pale ring with edematous periphery gradually


Kanerva et al. (2,3) gathered statistical data on occupational contact urticaria in Finland. The incidence more than doubled from 89 reported cases in 1989 to 194 cases in 1994. From 1990 to 1994, a total of 815 cases was reported. The most common causes were, in decreasing order, cow dander, natural rubber latex (NRL), and flour grains feed. These three groups comprised 79 of all cases. Reflecting this, the most affected occupations (per 100,000 workers) were bakers, processed food preparers, and dental assistants, in decreasing order. Contact urticaria, therefore, is a common problem that may affect many people in the course of their daily lives.


In adults, exposure to chromium by inhalation, oral or dermal contact can cause skin sensitization and eruptions, urticaria, a chromium-induced asthma, and bron-chospasms accompanied with tripling of plasma histamine levels (U.S. DHHS 2000). Cellular changes include leucocytosis or leucopenia, eosinophilia, monocytosis, and changes in the number and function of alveolar macrophages. Additionally, chromium exposure increases serum immunoglobulin levels and stimulates T cell mitogen responses (U.S. DHHS 2000). Overall, chromium causes a dysregulation of immune function resulting in immunostimulation.


Has been observed (Longley et al., 1993). Mast cell chymase has been reported to cleave membrane-associated SCF to a soluble and biologically active form. This mast cell-mediated process could serve to generate a feedback loop to enhance mast cell proliferation and function (Longley et al., 1997), and may be important for the etiology of mastocytosis. Transgenic mice overexpressing a form of SCF that could not be proteolytically released from keratinocytes did not develop mastocytosis, whereas similar animals expressing normal SCF in keratinocytes exhibited a phenotype resembling human cutaneous masto-cytosis (Kunisada et al., 1998). This observation suggested that formation of large amounts of soluble SCF can contribute to the pathology associated with mastocytosis in some patients. Several different mutations of the c-kit RTK that resulted in constitutive kinase activity have been found in human and rodent mast cell tumor cell lines (Furitsu et al., 1993 Tsujumura et al., 1994,...

Gentamicin sulfate

Additional Side Effects Muscle twitching, numbness, seizures, increased BP, alopecia, purpura, pseudotumor cerebri. Photosensitivi-ty when used topically. After ophthalmic use Transient irritation, burning, stinging, itching, inflammation, angioneurotic edema, urticaria, vesicular and maculopapular dermatitis, mydriasis, conjunctival paresthesia, conjunctival hyperemia, nonspecific conjunctivitis, conjuncti-val epithelial defects, lid itching and swelling, bacterial fungal corneal ulcers.

Unit 217

Serpins are a class of proteins involved in the regulation of serine and other types of proteases (Huber and Carrell, 1989 Potempa et al., 1994 Church et al., 1997). To date, DNA and protein sequencing have identified 400 members of the serpin superfamily (Whisstock et al., 1999). Interestingly, not all serpins are of an inhibitory nature (Remold-O'Donnell, 1993). Noninhibitory serpins include ovalbumin, angiotensinogen, and pigment epithelium-derived factor. In addition to being found in humans, serpins have been found in other mammals, insects, plants, and viruses. In humans, the majority of serpins regulate the functions of proteases involved in the body's response to injury. This includes roles in coagulation, fibrinolysis, inflammation, wound healing, and tissue repair (Huber and Carrell, 1989 Potempa et al., 1994 Church et al., 1997). Serpins have been implicated in various animal and human pathologies by the loss of a functional serpin gene through deletion or mutation, which...

Anaphylactic Deaths

Most anaphylactic deaths seen by a medical examiner are caused by insect bites, drugs, or foods. The symptoms of anaphylactic attack are faintness, itching of the skin, urticaria, tightness in the chest, wheezing, respiratory difficulty, and collapse. In anaphylactic deaths, the onset of symptoms is usually immediate or within the first 15 to 20 min. Beyond that time, one would need a well-documented medical history of gradually developing symptoms to implicate an anaphylactic reaction, e.g., the development of itching or wheals and flares. Death usually occurs within 1 to 2 h. In some insects, e.g., fire ants, the venom is directly toxic and death can occur without anaphylactic reaction if there were a large number of bites.13 In such cases, death typically occurs after 24 h.


Hypersensitivity responses were observed in some patients during infusions but, in general, these responses declined or resolved with continued weekly therapy. One patient had several recurrences of fever and chills and four others had recurrent episodes of urticaria (hives) and, on occasion, symptoms of angioedema (swelling in the tongue or throat). No clinically significant adverse laboratory results were observed in the patients. All patients developed antibodies to the rhIDU the titers peaked by 12 to 26 weeks and declined with time over 52 and 104 weeks. Further evaluations of these patients using epitope scanning technology confirmed that the patients tolerated all iduronidase epitopes over a 104-week period 29 . Complement activation was observed in four patients when comparing pre-and postinfusion specimens, but no significant clinical symptoms were observed. Peak consumption of complement occurred at weeks 6 and 12. By weeks 26 and 52, significant complement activation did...


Nicotine is an alkaloid found in tobacco, and is responsible for its pharmacological effects and addiction. Contact dermatitis from nicotine, considered as rare, has been more frequent since its use in transdermal systems. Irritant dermatitis is mainly encountered, as contact urticaria seems to be rare. Allergic contact dermatitis, sometimes generalized, has been reported, with positive patch testing to nicotine base (10 ethanol or petrolatum). No consequences have been reported in patients who start smoking again after skin sensitization.

Other Bee Products

Propolis, a waxlike material also known as bee glue, is collected by bees from buds on poplar and conifer trees and is used to repair cracks in hives. It may be weakly effective in killing a variety of bacteria and viruses. Limited studies have shown both stimulation and suppression of immune system activity. Propolis may facilitate the healing of mouth lesions and genital herpes lesions. One component of propolis, caffeic acid phenethyl ester (CAPE), has anti-inflammatory effects and, in one study, decreased the severity of disease in EAE, the animal model of MS. Whether propolis has an effect on MS is not known no published clinical studies have been undertaken of propolis use in MS. No studies have systematically examined the safety of propolis use. Propolis may cause allergic reactions, especially in people with allergies to bees or bee products. Royal jelly is recommended for many conditions, including some MS-associated symptoms such as weakness, depression, cognitive...

Erythema toxicum

Erythema toxicum neonatorum erythema neonatorum toxic erythema erythema neonatorum allergicum erythema papulo-sum urticaria neonatorum erythema dys-pepsicum Candidiasis miliaria pyoderma insect bite reaction varicella herpes simplex virus infection urticaria folliculitis transient neonatal pustular melanosis

Yellow fever vaccine

Immediate hypersensitivity reactions with rash, urticaria or asthma occur in less than 1 per million individuals and usually among those with known egg allergy Serious adverse reactions are extremely rare 22 cases of encephalitis have been reported to WHO since 1945, in relation to over 200 million doses of 17D yellow fever vaccine given worldwide. Most of those affected were children under 4 months of age


Among the several cases reported is one with hydralazine-induced SLE presenting as pyoderma gangrenosum-like ulcers (Peterson 1984). There are occasional studies about the association of LE with hereditary angioedema. All subtypes of LE have been reported to be coexistent with hereditary angioedema (see Gudat and Bork 1999). Duhra et al. (Duhra et al. 1990) reported in 1990 a female patient who developed DLE 6 years after the onset of hereditary angioedema. They tried to explain the coexistence of both diseases by C1 inhibitor deficiency, which can induce DLE. Duhra et al. believed that this association is rare, but its recognition is important because both diseases respond to danazol therapy. A single case showing an association between DLE and pseudoainhum has been reported (Sharma et al. 1998). Pseudoain-hum is a rare dermatologic complication presenting as a constricting band around the digits. The reported patient was a 32-year-old male with 10 years duration of DLE....


Initial rapid decline is due to distribution to the peripheral compartment and significant elimination, whereas the second phase is due, in part, to a slow efflux of the drug from the peripheral compartment. Metabolized by the liver with small amounts of unchanged drug excreted in the urine. Uses Metastatic carcinoma of the ovary after failure of first-line or subsequent chemotherapy. Breast cancer after combination chemotherapy has failed or there has been relapse within 6 months of adjuvant chemotherapy (prior therapy must have included an anthracycline unless contra-indicated). Second-line treatment of AIDS-related Kaposi's sarcoma. Non-FDA Approved Uses Alone or in combination with other chemothera-peutic drugs for advanced head and neck cancer, previously untreated extensive-stage small-cell lung cancer, adenocarcinoma of the upper GI tract, hormone-refractory prostate cancer, advanced non-small-cell lung cancer, and leukemias. Contraindications Hypersensitiv-ity to paclitaxel,...

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