Urticaria

URTICARIA

Q. 1

All of the following are true about solar urticaria EXCEPT:

 A

Common in females between age group 20-40 yrs.

 B

Lesions subsides spontaneously on avoiding exposure within 24 hours

 C

Some cases may develop severe urticaria/bronchospasm.

 D

Almost all cases are idiopathic

Q. 1

All of the following are true about solar urticaria EXCEPT:

 A

Common in females between age group 20-40 yrs.

 B

Lesions subsides spontaneously on avoiding exposure within 24 hours

 C

Some cases may develop severe urticaria/bronchospasm.

 D

Almost all cases are idiopathic

Ans. A

Explanation:

Common in females between age group 20-40 yrs. REF: Bolognia text bookmof dermatology, 2nd edition, vol 2 p. 1343

Solar urticaria

  • Common in females in 4th or 5th decade
  • Most cases are idiopathic
  • Urticarial and erythema occur on sun exposed areas and subside within 24 hrs
  • Some cases may develop serious bronchospasm or anaphylaxis

Q. 2 A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is
 A Fixed drug eruption
 B Licken planus
 C Urticaria pigmentosa    
 D Urticarial vasculitis
Q. 2 A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is
 A Fixed drug eruption
 B Licken planus
 C Urticaria pigmentosa    
 D Urticarial vasculitis
Ans. C

Explanation:

Urticaria pigmentosa

Urticaria is characterized by large, irregularly shaped pruritic, erythematous wheels

  •  Special forms of urticaria have special features (Dermographism, cholinergic urticaria, solar urticaria, or cold uritcaria)
  •     Most incidents are acute and self-limited over a period of 1-2 weeks
  • Chronic urticaria (episodes lasting> 6 weeks) may have an autoimmune basis
  • The most common immunologic mechanism is hypersensitivity mediated by IgE, seen for most patients with acute urticaria
  • The morphology of the lesions may vary over a period of minutes to hours, resulting in geographic or bizarre, pattern, true urticaria last less than 24 hours and often only 2-4 hours.
  • The most common cause of acute urticaria are foods, viral infections and medications Diagnosis – In vivo allergy skin testing and in vitro RAST testing
  • Determination of serum tryptase (Increased in anaphylaxis, systemic mastocytosis, non IgE mediated disease (“anaphylactoid reaction”)
  • ACE inhibitors and Angiotensin II receptors antagonist therapy is contraindicated. Urticaria pigmentosa (mastocytosis) – consists of multiple irregularly shaped hyperpigmented muscle which may present on the trunk and extremities.
  • Stroking the skin through the lesion with a blunt instrument elicits the classical “triple response of Lewis” called

Q. 3 Urticaria pigmentosa is a disorder of ?
 A Mast cells
 B

Neutrophils

 C Eosinophils
 D Lymphocytes
Q. 3 Urticaria pigmentosa is a disorder of ?
 A Mast cells
 B

Neutrophils

 C Eosinophils
 D Lymphocytes
Ans. A

Explanation:

Mast cells

REF: Rook’s Er ed p. 22.31

Urticarial pigmentosa and mastocytosis are disorders of mast cells


Q. 4

A man came to the casualty with some skin lesions after exposure to the sun. He is allergic to sunlight. Solar urticaria is characterized by:

 A

Stinging

 B

Erythema

 C

Wheal formation

 D

Loss of sensation

Q. 4

A man came to the casualty with some skin lesions after exposure to the sun. He is allergic to sunlight. Solar urticaria is characterized by:

 A

Stinging

 B

Erythema

 C

Wheal formation

 D

Loss of sensation

Ans. C

Explanation:

  • Uncommon sunlight-induced whealing confined to exposed body sites.
  • Eruption occurs within minutes of exposure and resolves in a few hours. Very disabling and sometimes life threatening.
  • Action spectrum is UVB, UVA, and visible light or any combination thereof. Most commonly UVA.
  • Is an immediate type I hypersensitivity response to cutaneous and/or circulating photo allergens.
  • Therapy: multiple phototherapy sessions in low but increasing doses on the same day (“rush hardening”); oral immunosuppressive agents or plasmapheresis.
  • Prevention: sun avoidance, sunscreens with high protection factors against action spectrum.
 
Ref: Suurmond D. (2009). Section 10. Photosensitivity, Photo-Induced Disorders, and Disorders by Ionizing Radiation. In D. Suurmond (Ed),Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology,6e.

Q. 5

Which of the following conditions produce a positive Darier’s sign?

 A

Darier’s disease

 B

Urticaria pigmentosa

 C

Hailey Hailey disease

 D

Telangiectasia macularis eruptiva perstans

Q. 5

Which of the following conditions produce a positive Darier’s sign?

 A

Darier’s disease

 B

Urticaria pigmentosa

 C

Hailey Hailey disease

 D

Telangiectasia macularis eruptiva perstans

Ans. B

Explanation:

Urticaria pigmentosa is the most common form of cutaneous mastocytosis presenting as reddish-brown monomorphic maculopapules, plaques or nodules appear in asymmetrical distribution anywhere on the body except the face, head, palms and soles.

They urticate within a fewminutes of gentle rubbing (Darier’s sign) & subsides within an hour.

Telangiectasia macularis eruptiva perstan is a form ofcutaneous mastocytosis in adults presenting with red, telangiectatic macules, especially on the trunk, which tend not to urticate on rubbing. Other forms are mastocytoma & diffuse cutaneous mastocytosis.

NB: darier’s sign is also positive in juvenile xanthogranuloma and acute lymphoblastic leukaemia of neonates.

Ref: Rook’s textbook of dermatology, Edition-8, Page-22.31-32.


Q. 6

All are SLE associated rashes, EXCEPT:

 A

Recurring urticaria

 B

Lichen planus–like dermatitis

 C

Llupus profundus

 D

Lichen plannus pigmentosus

Q. 6

All are SLE associated rashes, EXCEPT:

 A

Recurring urticaria

 B

Lichen planus–like dermatitis

 C

Llupus profundus

 D

Lichen plannus pigmentosus

Ans. D

Explanation:

Lupus dermatitis can be classified as 

1. Discoid lupus erythematosus (DLE), 
2. Systemic rash
3. Subacutecutaneous lupus erythematosus (SCLE)
 
Discoid skin lesions
Circular with slightly raised, scaly hyperpigmented erythematous rims and depigmented with atrophic centers. 
Disfiguring, particularly on the face and scalp. 
Treatment -topical or locally injected glucocorticoids and systemic antimalarials. 
The most common SLE rash is a photosensitive, slightly raised erythema, scaly, on the face, ears, chin, V region of the neck and chest, upper back, and extensor surfaces of the arms. 
 
Other SLE rashes are:
Recurring urticaria, 
Lichen planus–like dermatitis
Bullae
Llupus profundus
Ref: Harrison, E-18, P-2734.

Q. 7

A 25 year old man presents with recurrent episodes of flexural exzema contact urticaria, recurrent skin infections and severe abdominal cramps and diarrhoea upon taking sea foods. He is suffering from :

 A

Seborrheic dermatitis

 B

Atopic dermatitis

 C

Airborne contact dermatitis

 D

Nummular dermatitis

Q. 7

A 25 year old man presents with recurrent episodes of flexural exzema contact urticaria, recurrent skin infections and severe abdominal cramps and diarrhoea upon taking sea foods. He is suffering from :

 A

Seborrheic dermatitis

 B

Atopic dermatitis

 C

Airborne contact dermatitis

 D

Nummular dermatitis

Ans. B

Explanation:

B i.e. Atopic dermatitis


Q. 8

A patient gets reccurent urticaria while doing exercise and on exposure to sunligh. Which of the following is most like cause:

 A

Chronic Idiopathic Utricaria

 B

Universal dermographism

 C

Cholinergic Utricaria

 D

Photdermatitis

Q. 8

A patient gets reccurent urticaria while doing exercise and on exposure to sunligh. Which of the following is most like cause:

 A

Chronic Idiopathic Utricaria

 B

Universal dermographism

 C

Cholinergic Utricaria

 D

Photdermatitis

Ans. C

Explanation:

C i.e. Cholinergic Urticaria

–        Patients developing urticaria (itchy wheals surrounded by erythema) under the influence of any stimulus which includes sweating by increasing core body temperature like physical exertion, emotional upset, and exposure to sun, heat, hot bath or spicy foodQ favours the diagnosis of cholinergic urticaria.

Antihistaminics of H1 receptor blockerQ are drug of choice for treatment of urticaria.


Q. 9

A 5 year old male child has multiple hyperprigmented macules over the trunk. On rubbing the lesion with the rounded end of a pen, he developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is :

 A

Fixed drug eruption

 B

Lichen planus

 C

Urticaria pigmentosa

 D

Urticarial vasculitis

Q. 9

A 5 year old male child has multiple hyperprigmented macules over the trunk. On rubbing the lesion with the rounded end of a pen, he developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is :

 A

Fixed drug eruption

 B

Lichen planus

 C

Urticaria pigmentosa

 D

Urticarial vasculitis

Ans. C

Explanation:

C i.e. Urticaria pigmentosa 

Darrier sign is development of urticaria and erythema around the pale-yellow to reddish-brown macules after mild trauma, including scratching or rubbing of the lesion(2. It is seen mostly (but not always) in urticaria pigmentosa. However, it is not 100% specific for mastocytosis as it is also rarely seen in juvenile Xanthogranuloma and acute lymphoblastic leukaemia of neonates.

Urticaria Pigmentosa (UP)/Mastocytosis

– Mastocytosis is mast cell hyperplasia in  1 organs: bone marrow, liver, spleen, lymph nodes, gastrointestinal tract and skin. So mast cell activation may produce symptoms like, pruritis, flushing, urtication, abdominal pain, nausea, vomiting, diarrhea, musculo skeletal pain, vascular instability, headache and neuropsychiatric difficulties.

UP (a type of cutaneous mastocytosis) is the most common manifestation of mastocytosis, both in adults & children.

–  Numerous pale yellow tan to reddish brown monomorphic macules or slightly raised papules develop in a symmetrical distributions anywhere on the body with generally less involvement of the sun exposed areas, with the highest concentration usually being on the trunk and thighsQ. Also generally spared (or less involved) are face, scalp, head, palms & soles. – The edges of lesion are not completely sharp. It is not uncommon for lesion to become pigmented, hence name urticaria pigmentosa.

–  Development of urticaria, erythema & itching around the lesion after mild trauma, including scratching or rubbing of lesionQ is called Darier Sign. It is seen in UP.

–  Climatic temperature, skin friction, ingestion of hot beverages, spicy foods, alcohol, opioids or other drugs may cause histamine release from mast cells and exacerbate mastocytosis

– 3 types/ forms of UP are

  1. Juvenile type develop mostly in P, year of life and usually remits spontaneously during adolescence
  2. Adult papular type persists.
  3. Adult telangiectasia macularis eruptive perstans of Parker & Weber: in which telangiectatic macules start to appear, persist and increase in number over the years.

Urticarial Vasculitis

–  An important characteristic of urticaria is its transience but rarerly it may stay for days rather than hours & leave a brownish stain

–  It is due to involvement of small vessels

–  Vasculitis urticari typically persist longer than 72 hours, where as conventional urticaria often has a duration of less than 24 -48 hours.

Fixed drug Erruption

– Inflamatory patches appear within hours at the same sites on every occasionQ the drug is administered

Leave pigmentation

– Common drugs are dapsone, tetracycline, sulfonamides, mefenimic acid.


Q. 10

A patient presented with the following after irritation on the skin.Which of the following cells is involved in this condition?

 A

Eosinophils

 B

Basophils

 C

Mast Cells

 D

All of the above

Q. 10

A patient presented with the following after irritation on the skin.Which of the following cells is involved in this condition?

 A

Eosinophils

 B

Basophils

 C

Mast Cells

 D

All of the above

Ans. C

Explanation:

Ans:C.)Mast Cells.

The patient in question is suffering from Urticaria Pigmentosa.


  • Urticaria pigmentosa (also known as generalized eruption of cutaneous mastocytosis (childhood type)
  • Urticaria pigmentosa is characterized by excessive amounts of mast cells in the skin.
  • Red or brown spots are often seen on the skin, typically around the chest and forehead.
  • These mast cells, when irritated (e.g. by rubbing the skin, heat exposure), produce too much histamine, triggering an allergic reaction that leads to hives localized to the area of irritation, sometimes referred to as Darier’s sign. 

Q. 11

A man has recurrent urticaria following exercise and coming out in sun. Diagnosis is:

 A

Cholinergic urticaria

 B

Atopic reaction

 C

Photo dermatitis

 D

Chronic idiopathic urticaria

Q. 11

A man has recurrent urticaria following exercise and coming out in sun. Diagnosis is:

 A

Cholinergic urticaria

 B

Atopic reaction

 C

Photo dermatitis

 D

Chronic idiopathic urticaria

Ans. A

Explanation:

Ans. a. Cholinergic urticaria

  • Cholinergic urticaria develops due to acetyl choline liberated from post ganglionic cholinergic enervated sweat glands under the influence of any stimuli which induces sweating by increasing core body temperatureQ.
  • Precipitating factors are exercise/physical exertion°, emotion upset°, exposure to sun/heat° and hot bath/foodQ

Physical Urticaria

  • Dermographism 
  • Solar urticaria
  • Cold urticaria        
  • Cholinergic urticaria

Dermographism

  • This is exaggerated triple response of lewisQ.
  • In some patients of urticaria mark easily when their skin is scratched or rubbed with a blunt objectQ
  • It is not influenced by an atopic diathesis a.nd has a duration of less than 5 years.

Urticaria Vasculitis

  • Transient° but rarely it may stay for days rather than hours and leave a brownish stain.
  • It is due to involvement of small vesselsQ

Urticaria pigmentosa/Mastocytosis

  • There are excess mast cells° in many tissues but mainly manifest in the skinQ
  • Multiple pink or red brown macule or papuleQ develops over the trunk and limbs.
  • Lesions may be intensely itchy and patient may experience discomfort and erythema when bathing.
  • Rubbing or heating may result in its swelling and a red halo- Darrier’s signQ
  • Sometimes alcohol, opioids or other drugs may cause histamine release from visceral mast cell deposits

Cholinergic Urticaria

  • Urticaria develops due to acetyl choline liberated from post ganglionic cholinergic enervated sweat glands under the influence of any stimuli which induces sweating by increasing core body temperatureQ.
  • Characteristic feature is small size pruritic wheals surrounded by large erythemaQ

Precipitating Factors

  • Exercise/Physical exertionQ
  • Emotion upsetQ
  • Exposure to sun/heatQ
  • Hot bath/foodQ

Q. 12

A 37-3 eiii p. scats with multiple, nen) wheals, with itching for 1) minutes at the site. The most probable diagn

 A

Dermatographic urticaria

 B

Pressure urticaria

 C

Acute urticaria

 D

Chronic urticaria

Q. 12

A 37-3 eiii p. scats with multiple, nen) wheals, with itching for 1) minutes at the site. The most probable diagn

 A

Dermatographic urticaria

 B

Pressure urticaria

 C

Acute urticaria

 D

Chronic urticaria

Ans. A

Explanation:

Ans. a. Dermatographic urticaria


Q. 13

A 60 years old man presented with itchy tense blisters on normal looking skin and urticarial rash. Investigation done for the diagnosis:

 A

Direct immunofluorescence

 B

Indirect immunofluorescence

 C

Histopathology

 D

Cytopathology

Q. 13

A 60 years old man presented with itchy tense blisters on normal looking skin and urticarial rash. Investigation done for the diagnosis:

 A

Direct immunofluorescence

 B

Indirect immunofluorescence

 C

Histopathology

 D

Cytopathology

Ans. A

Explanation:

Ans. a. Direct immunofluorescence

A 60 years old man presented with itchy tense blisters on normal looking skin and urticarial rash. This patient is suffering from pemphigoid. Investigation done for the diagnosis direct immunofluorescence.


Q. 14

Darrier’s sign is seen in ‑

 A

Darrier’s disease

 B

Urticaria pigmentosa

 C

Allergic vasculitis

 D

Atopic dermatitis

Q. 14

Darrier’s sign is seen in ‑

 A

Darrier’s disease

 B

Urticaria pigmentosa

 C

Allergic vasculitis

 D

Atopic dermatitis

Ans. B

Explanation:

Ans. is ‘b’ i.e., Urticaria pigmentosa

  • Urticaria pigmentosa is a familial cutaneous disorder characterised by generalised distribution of red brown macules.
  • Each lesion represents a collection of mast cells in the dermis with hyperpigmentation of overlying epidermis.
  • The most characteristic features is that these lesions urticate on scratching.
  • Light scratching with the point of forceps or rounded tip of a pen or even rubbing causes these mast cells to degranulate leading to localized urticaria (become red swollen and enlarged) —> Darrier’s Sign Extensive release of histamine from mast cell degranulation may result in – Headache, flushing diarrhea and pruritis.


Leave a Reply

%d bloggers like this:
Malcare WordPress Security