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1 ulcer bulla Scar nodule vesicle

2 Scale Plaque Patch pustule

3 crust scab

4 Contact Dermatitis

5 Definition Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy-causing substance irritant =irritating acid, base, metal salt and etc. allergen =allergy-causing substance dye, oil, chemical used for fabrics, rubbers, cosmetic and etc.

6 Classification irritant contact dermatitis allergic contact dermatitis

7 Irriitant dermatitis is an inflammatory reaction in the skin resulting from exposure to a substance that cause an eruption in most people who come in contact with it. Allergic contact dermatitis is an acquired sensitivity to various substances that produce inflammatory reactions in those, and only those, who have been previously exposed to the allergen.

8 irritant contact dermatitis by strong acid Acid produces a brownish scab of the skin, beneath which is an ulceration that heals slowly.

9 irritant contact dermatitis caused by strong base

10 bullae, erythema irritant contact dermatitis ( pesticide )

11 irritant contact dermatitis caused by chemical

12 allergic contact dermatitis ( drug to treat underarm odour ) underarm odour =bromhidrosis

13 The bromidrosis is caused by bacterial decomposition of apocrine sweat, producing fatty acids with distinctive offensive odours.

14 Chronic allergic contact dermatitis metal claspers lichenification

15 subacute allergic contact dermatitis metal buckle

16 acute allergic contact dermatitis plant

17 A large number of plants, including trees, grasses, flowers, vegetables, fruits, and weeds, are potential causes of dermatitis. For example poison ivy[ 植 ] 毒葛 mango

18 allergic contact dermatitis cosmetic

19 allergic contact dermatitis cosmetic

20 allergic contact dermatitis cosmetic

21 Post-treatment

22 allergic contact dermatitis caused by mango

23 Edema of foreskin allergic contact dermatitis drug

24 allergic contact dermatitis drug

25 The Difference Irritant dermatitis allergic contact dermatitis Substance acids alkaline varied The reaction burn allergic Feeling pain itch People everyone someone latent period Patch test no yes do not use it positive

26 chamber mark Patch test A piece of blotting paper is soaked with the suspected allergen, then it is taped to your skin for 24 to 48 hours. If a rash develops on the site, there is a allergen.

27 The patch sites need to be evaluated after 2 day The patch sites need to be evaluated again at 4 or 5 day, because positive reaction may not appear earlier.

28 Allergy Skin Prick Test

29 Clinical Manefestation contact spot with clear boundary erythema or blister transparent itch or pain course: 1-2w long-term repeatedly contact: lichenification

30 Diagnosis 1.contact history 2.clinical manefestation 3. patch test

31 Treatment Firstly, far from the allergen or irritant (1)to get rid of suspected allergen (2) local treatment (3)systemic treatment antihistamine calcium Vitamin C corticosteroids

32 For the acute dermatitis,wet compresses of solution are the treatment of choice

34 Chronic allergic contact dermatitis metal claspers lichenification

35 When the eruption is limited, local application of topical corticosteroid cream is superior to any other local application.

36 Drug Eruption

37 Definition An adverse cutaneous reaction produced by ingestion, parenteral use, or local application of a drug, which may produce various morphologic patterns and types of lesions. It is also called drug rash.

38 Drug eruption easily caused by 1.antibioltic 2. NSAIDs( nonsteroidal antiinflammatory drug) 3.sulfa drug 4.sedative 5.blood serum and antitoxin 6.traditional Chinese medicine

39 Pathogenesis (1)allergic reaction ( most ) (2)non-allergic reaction ( a few )

40 Features of allergic drug eruption 1. Occur in a few persons 2. Not relate to pharmic action and dosage 3. Latent period is commonly 4-20 days 4. Lesion is multiple 5. Cross-reaction 6. Corticosteroid is effective

41 Clinical Manefestation 1.mild drug rash 1) Fixed drug eruption 2) Urticarial eruption 3) Exanthems

42 4) Erythema multiforme drug eruption 5) Purpuric drug eruption

43 Fixed drug eruption

44 Urticarial drug eruption

45 Exanthems

46 Exanthems

47 Erythema multiforme drug eruption

48 Erythema multiform Typically,a ring of erythema forms around the periphery, and centrally the lesions become flatter, more purpuric, and dusky. The lesion is the classic target or iris.

49 Purpuric drug eruption

50 1. Severe drug eruption 1) exfoliative dermatitis 2) drug-induced bullosa epidermolysis 3) serious Erythema multiforme drug eruption

51 drug-induced bullosa epidermolysis

52 Exfoliative dermatitis

53 Serious erythema multiforme drug eruption

54 Diagnosis 1.history of taking medicine 2. Latent period 3. Lesion appearred abruptly 4.drug test

55 Treatment 1.stop using suspected drug 2.local treatment 3.systemic treatment A.corticosteroid B.calcium C.antihistamine D.supporting treatment E.antibacterial

56 wheal Acute evanescent circumscribed edema Localized edema

57 Definition of Urticaria (Hives) Itchy, swollen, red wheals or patches on the skin that appear suddenly as a result of the body's adverse reaction to certain allergens. They can appear anywhere on the body including the face, lips, tongue, throat, or ears. Hives vary in size and can last for minutes or hours.

59 Definition of Angioedema Swelling similar to urticaria (hives), but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the scrotum. The most distensible tissues

60 Introduction Urticaria and Angioedema Urticaria Angioedema Angioedema is a special urticaria, is called giant urticaria

61 Incidence and Prevalence of Urticaria Urticaria is extremely common 15% to 25% of the population experience an urticaria at some time in life 40% will experience urticaria alone 10% will experience angioedema alone 50% will have urticaria and angioedema at the same time

62 Classification of Urticarial Acute Urticaria Evolves over days to weeks Wheal individual last less than 24 hrs Resolution within 6 weeks of onset Chronic Urticaria Daily episode of urticaria lasting more than 6 weeks

63 Etiology of Urticarial Allergic Triggers Acute Urticaria Drugs Foods Food additives Viral infections Insect bites and stings Contactants and inhalants (includes animal dander and latex) Chronic Urticaria Physical factors cold heat dermatographic pressure solar Idiopathicr about 75% the unclear

The Pathogenesis of Urticaria: Cellular Mediators The urticarial wheal Increased capillary permeability, which allows proteins and fluids to

64 The Pathogenesis of Urticaria: Cellular Mediators The urticarial wheal Increased capillary permeability, which allows proteins and fluids to extravasate Increased of histamine from the mast cells situated around the capillary The mast cell is the primary effector cell in urticarial reaction

65 When mast cell release the histamine When mast cell release the histamine The capillary permeability will increase The small vessel will be dilative There are some other changes happening But in the pathogenesis of urticaria they are the most important

66 Clinical Manifestation Acute Urticaria wheal, erythema last few minutes to few hours appear suddenly and disappear soon without trails after extinction severe cases

67 Severe cases of urticaria There are a lot of accompany syndromes in severe case. Some syndromes are life-threatening respiratory tract shortness of the breath gastrointestinal tract nausea, vomiting, abdominal pain cardiovascular system hypotension

68 Severe cases of urticaria The edema can appear on skin and in the mucous membrane of respiratory tract, gastrointestinal tract, and accompany the dilatation of small vessel.

69 Other variants of urticaria Dermatographia Factitious urticaria Dermatographia is a sharply localized edema or wheal with a surrounding erythematous flare occurring within seconds to minutes after the skin has been stroked.

70 Diagnosis wheal erythema onset and disappear suddenly itch

71 Treatment of Urticaria Pharmacologic Options Antihistamines First-generation H 1 Second-generation H 1 Tricyclic antidepressants (eg, doxepin) Combined H 1 and H 2 agents Corticosteroids Severe acute urticaria avoid long-term use

72 Treatment of Urticaria Pharmacologic Options calcium Vitamin C 10% calcium gluconate solution Reduce the capillary permeability local treatment Lotion contains menthol, phenol, camphor is helpful to antipruritic 薄荷, 酚, 樟脑

73 H 1 -Receptor Antagonists Pros and Cons for Urticaria and Angioedema First-generation antihistamines Advantages: relatively inexpensive Disadvantages: Sedating, anticholinergic

74 H 1 -Receptor Antagonists: Pros and Cons for Urticaria and Angioedema Second-generation antihistamines Advantages: No sedation; no adverse anticholinergic effects; Disadvantages: Prolongation of QT interval; ventricular tachycardia (astemizole only) in a patient subgroup 阿司咪唑西替利嗪非索非那定氯雷他定

75 湿疹 Eczema 非传染性变态反应性炎症性皮疹形态多样自觉瘙痒易复发

76 病因及发病机理 (Pathogenesis) 外因 : 食物吸入物病原微生物日光气候化妆品肥皂洗衣粉等内因 : 慢性感染病灶内分泌及代谢改变循环障碍精神神经因素遗传因素异位性皮炎发病机理 : 主要为 IV 型变态反应

77 临床表现 (Clinical manifestation) 根据皮损的形态分为三期急性湿疹亚急性湿疹慢性湿疹

78 ( 一 ) 急性湿疹多形性皮损渗出明显剧痒和灼热感夜晚加重

79 急性湿疹

80 急性湿疹

81 急性湿疹

82 传染性湿疹样皮炎 infectious eczematoid dermatitis

83 ( 二 ) 亚急性湿疹红斑水疱渗出瘙痒减轻糜烂逐渐愈合鳞屑及结痂明显

84 亚急性湿疹

85 亚急性湿疹

86 亚急性湿疹

87 ( 三 ) 慢性湿疹由急性及亚急性期迁延皮肤苔藓样变色素沉着或色素减退病情反复

88 慢性湿疹

89 慢性湿疹

90 湿疹的特点多形性对称性易渗出瘙痒易复发

91 常见的慢性湿疹类型手湿疹多由接触物引起足湿疹可由足癣诱发乳房湿疹多因哺乳引起外阴及肛门湿疹小腿湿疹多继发于小腿静脉曲张

92 手湿疹 eczema

93 肛周湿疹

94 乳房湿疹

95 房疹乳湿

96 脐窝湿疹

97 淤滞性皮炎 (stasis( stasis dermatitis) 即静脉曲张性湿疹

98 淤滞性皮炎 (stasis( dermatitis) 即静脉曲张性湿疹

99 特殊类型的湿疹钱币状湿疹好发于四肢皮损直径 1 3 厘米汗疱疹主要见于手足遗传过敏性皮炎异位性皮炎 (Atopic Dermatitis)

100 诊断 (Diagolosis) 主要根据皮损特点

101 鉴别诊断接触性皮炎神经性皮炎

102

103

104 治疗 (Treatment) ( 一 ) 去除诱因食物理化刺激物消除慢性病灶治疗全身性疾病

105 ( 二 ) 内用疗法原则 : 消炎止痒抗组胺药物 : 扑尔敏酮替酚息斯敏克敏能钙剂 : 维丁胶钙葡萄糖酸钙益钙灵钙尔奇普鲁卡因封闭激素 : 应严格控制使用中医中药 : 小柴胡汤六味地黄丸等

106 ( 三 ) 局部治疗原则 : 清洁止痒抗菌消炎收敛及角质促成剂 1 急性湿疹湿敷为主 3% 硼酸 0.1% 雷佛奴尔 2 亚急性湿疹焦油类皮质类固醇乳剂糊剂等 3 慢性湿疹煤焦油类皮质类固醇软膏或霜剂

107 Test

108

109

110

少量食物蛋白质, 都可能会引起剧烈的过敏反应如果测试者对某种食物过敏, 被点刺的皮肤部位在短时间内会出现红肿热痛和痒等症状, 故测试者很快就可以知道结果主要针对

少量食物蛋白质, 都可能会引起剧烈的过敏反应如果测试者对某种食物过敏, 被点刺的皮肤部位在短时间内会出现红肿热痛和痒等症状, 故测试者很快就可以知道结果主要针对异样皮肤现象 : 过敏与敏感 Created 09/10/2015 15:25 一个午餐坐下来, 就会常听到有人说, 自己这个不能吃, 那个不能碰, 因为会皮肤过敏, 而有些人则是什么都没碰过, 肌肤干燥难耐, 红肿发痒, 甚至脱皮出现, 而这种现象可以说是敏