皮肤性病学教案及讲稿2006级留学年级课程名称皮肤性病学授课专业皮肤性病学生教师单葵职称学时讲师授课方式大课示教题目章节《urticaria》教材名称作者Liu Tong《Dermatovenereology》Dean'sXianofficeofJiaotong版次出版社FirstUniversityNovember2004教学The definition of urticaria1.目2.The etiology and pathogenesis of urticaria.的3.The clinical manifestations of urticaria要4.The treatment of urticaria.求教1. The etiology and pathogenesis of urticaria学2Theclinical manifestations of urticaria难3.Thetreatment of urticaria.点教Thedefinitionofurticaria1学2Theclinical manifestations and some special sorts ofurticaria重3.The treatment of urticaria, especially how to deal with shock or laryngeal edema or dyspnea点外语要求教学方法大课讲述、多媒体、彩色图谱、临床病例手段参考《临床皮肤病学》赵辨等主编，2001年江苏科学技术出版社1.资料2.《AnderwsDiseasesofskin》（第九版英文影印版）Richard.B.O等主编，科学出版社教研室意见教学组长：单葵教研室主任：李惠2009年9月7日
皮肤性病学教案及讲稿 课程名称 皮肤性病学 年级 2006 级留学 生 授课专业 皮 肤 性 病 学 教 师 单 葵 职称 讲 师 授课方式 大课 示教 学时 1 题目章节 《urticaria》 教材名称 《Dermatovenereology》 作者 Liu Tong 出 版 社 Dean’s office of Xi’an Jiaotong University November 2004 版次 First 教 学 目 的 要 求 1. The definition of urticaria. 2. The etiology and pathogenesis of urticaria. 3. The clinical manifestations of urticaria . 4. The treatment of urticaria. 教 学 难 点 1. The etiology and pathogenesis of urticaria. 2. The clinical manifestations of urticaria. 3. The treatment of urticaria. 教 学 重 点 1. The definition of urticaria. 2. The clinical manifestations and some special sorts of urticaria. 3. The treatment of urticaria, especially how to deal with shock or laryngeal edema or dyspnea. 外语 要求 教学 方法 手段 大课讲述、多媒体、彩色图谱、临床病例 参考 资料 1. 《临床皮肤病学》赵辨等主编，2001 年江苏科学技术出版社 2. 《Anderws Diseases of skin》（第九版英文影印版）Richard.B.O 等主编，科学出版社 教研 室意 见 教学组长：单葵 教研室主任：李惠 2009 年 9 月 7 日
辅助手段教学内容时间分配UrticariaDefinition3分钟Urticaria is avery common disease and isa vascular reaction of the skin characterized bythe appearance of wheals, white or red evanescent plaques generally surrounded by a red haloor flare and associated with severe itching, stinging,or pricking sensations. (picturel)Etiology5分钟1. Food1分钟The most allergenic foods are shellfish, shrimps, crab, chocolate, nuts, peanuts, tomatoesstrawberries, melons, pork,cheese,garlic,onions, and spices.Eggs and milk always induce urticaria in children.2.Medicines1分钟Many medicines can start urticaria by allergy, the most common drugs are as follows.penicillin, serum, vaccine,furazolidone, sulfanilamideand so onSometimesafewdrugscandirectly stimulate mast cellstoproducehistamine,likeaspirinmorphine, codeine, quinine, etc.3.Infections1分钟Infections caused by all organisms areanother possiblereasons to induceurticariaThemost common organism isvirusof upperrespiratoryand staphylococcus aureusChronic infections of the patients cannot be easy verified as thepathogen of urticaria, itmust be tested by therapy2分钟4. Physical factors:Cold, hot, sunlight, friction and pressure5.Animals and plants:Urticaria can be induced by animal's fur skin or pollen or stinging of insects.6.Spirit factors:in some cases, stress can trigger urticaria, but in another cases stress may lead to histaminereleasing7.Diseases of internal organsRheumatic disorder, rheumatoid arthritis, systemic lupus erythema, malignant tumor,disorder of endocrine and some others can be another reasons of urticaria,5分钟Pathogenesis3分钟1.AllergyThe mast cell is the primary effector cell in urticarial reactions.The mast cell granules containing heparin and histamine disappear or almost disappearduring wheal, and then degranulated.Mast cell mediators can cause activation and recruitment of eosinophils,neutrophils, andpossiblybasophiles.Other substancesbesideshistaminemaycausevasodilation and capillarypermeabilityandtherebymaypossiblybecomemediators ofurticariaand angioedemaThese are serotonin,slow-reacting substances(leukotrienes),prostaglandins,proteases,bradykinin,andvarious otherkinins.2分钟2.Not comingfrom allergySome factors can lead to releasing of histamine from mast cells. They include medicineslike atropine, morphine, quinine, aspirin, pilocarpine, papaverine, polymyxin B, codeine,and etc. or some simple compound like amine, tween 80.Anotherfactors aretoxins coming from snake, bacteria,jellyfish, insect and so on.food like animal with shells, lobster, mushroom and strawberry can stimulatehistamine
教学内容 辅助手段 时间分配 Urticaria Definition Urticaria is a very common disease and is a vascular reaction of the skin characterized by the appearance of wheals, white or red evanescent plaques generally surrounded by a red halo or flare and associated with severe itching, stinging, or pricking sensations. (picture1) Etiology 1. Food The most allergenic foods are shellfish, shrimps, crab, chocolate, nuts, peanuts, tomatoes, strawberries, melons, pork, cheese, garlic, onions, and spices. Eggs and milk always induce urticaria in children. 2. Medicines Many medicines can start urticaria by allergy, the most common drugs are as follows: penicillin, serum, vaccine, furazolidone, sulfanilamide and so on . Sometimes a few drugs can directly stimulate mast cells to produce histamine, like aspirin, morphine, codeine, quinine, etc. 3.Infections Infections caused by all organisms are another possible reasons to induce urticaria. The most common organism is virus of upper respiratory and staphylococcus aureus. Chronic infections of the patients cannot be easy verified as the pathogen of urticaria; it must be tested by therapy 4. Physical factors: Cold, hot, sunlight, friction and pressure 5. Animals and plants : Urticaria can be induced by animal's fur skin or pollen or stinging of insects. 6. Spirit factors: In some cases, stress can trigger urticaria, but in another cases stress may lead to histamine releasing 7. Diseases of internal organs Rheumatic disorder, rheumatoid arthritis, systemic lupus erythema, malignant tumor, disorder of endocrine and some others can be another reasons of urticaria, Pathogenesis 1. Allergy The mast cell is the primary effector cell in urticarial reactions. The mast cell granules containing heparin and histamine disappear or almost disappear during wheal, and then degranulated. Mast cell mediators can cause activation and recruitment of eosinophils, neutrophils, and possibly basophiles. Other substances besides histamine may cause vasodilation and capillary permeability and thereby may possibly become mediators of urticaria and angioedema. These are serotonin, slow-reacting substances (leukotrienes), prostaglandins, proteases, bradykinin, and various other kinins. 2. Not coming from allergy Some factors can lead to releasing of histamine from mast cells. They include medicines like atropine, morphine, quinine, aspirin, pilocarpine, papaverine, polymyxin B, codeine, and etc. or some simple compound like amine, tween 80. Another factors are toxins coming from snake, bacteria, jellyfish, insect and so on. food like animal with shells, lobster, mushroom and strawberry can stimulate histamine 3 分钟 5 分钟 1 分钟 1 分钟 1 分钟 2 分钟 5 分钟 3 分钟 2 分钟
releaseinsomecases.15分钟Clinicalmanifestations4分钟1.Acute urticariaAcute urticaria always occurs abruptly, it wil evolve over days to weeks, producingevanescent wheals that individuallyrarelylastmore than 12hours,withcomplete resolutionoftheurticariawithin6weeksofonset.(picture2)Sometimes it will show allergic shock features, blood pressure of patients may fall, or theywill haveabdomenache,orarepanicky,dysphoria,nauseaandvomitus,somepatientswillhave severeabdomen ache, likeacuteabdomen;dyspnea willappear onsomecases ifedemaappear at respiratorytract; infew cases it may accompanied by septicemia while thepatientshave high fever, shivering with cold or fear.2.Chronic urticaria2分钟Daily episodes of urticaria and/or angioedema lasting more than 6 weeks is designatedchronicurticaria,whichpredominantlyaffects adultsand istwiceas common in womenasinmenGeneral symptoms of chronic urticaria are mild, more wheals or a few wheals, it will recurrepeatedly,keepingfor several monthsoryears, it will sharpen in special timeor not.Causescannotbefoundinmanycases.3.Dermatographism2分钟Dermatographism is also known as factitious urticaria and is a sharply localized edema orwheal witha surrounding erythematous flare occurring within seconds to minutes aftertheskin has been scratched. (picture3,4)4. Cholinergic urticaria2分钟Cholinergic urticaria is produced by the action of acetylcholine on the mast cell,characterized byminute, highlypruritic,punctatewheals or papulesLesions persist 30 to 90 minutes and are followed by arefractory period up to 24 hours.Itmaybe induced in the susceptiblepatientby exercise, emotional stress, increasedenvironmental temperature,or intradermal injection ofnicotinepicrateormethacholine.5.SolarurticariaIt is always induced by media or longultraviolet ray, and appears soon on unshielded skin1分钟when exposed to sunlight.It is classified by the wavelengths of light that precipitate in the reaction6.Pressure urticariaIt is characterized bythedevelopmentof swellingwithpain that occurs4to6hours after1分钟localareabeingpressedThere may be a latent period of as much as 24 hours before lesions develop7.AngioedemaItalways occur at rarefaction areas, likeeyelid, lip,external genital organs,hand and foot3分钟It appears abruptly,and shows localized edema features, it will diminishafter1 to3daysIf angioedema appears at mucosa of larynx, it cancause dyspnea, even death. (picture5,6)DiagnosisThe diagnosis of urticaria can be made upon its typical clinical manitestations, in details2分钟wheals; fast appearing and diminishing, no trace after diminishing and specialties at everyphase.It can be diagnosed easily,but cause-diagnosis are verydifficult in many casesSystemic treatment9分钟1.Acute urticaria2分钟The mainstay of treatmentofacuteurticaria is administration ofantihistaminesVitamine C can also be used to decrease permeabilities of vessels.654-2orother samesortsofdrugs canbechoseninacuteurticariafollowedbyabdomen-ache.If it were accompanied byinfection of bacteria,appropriate antibiotics therapy would be
release in some cases. Clinical manifestations 1.Acute urticaria Acute urticaria always occurs abruptly, it will evolve over days to weeks, producing evanescent wheals that individually rarely last more than 12 hours, with complete resolution of the urticaria within 6 weeks of onset. (picture2) Sometimes it will show allergic shock features, blood pressure of patients may fall, or they will have abdomen ache, or are panicky, dysphoria, nausea and vomitus; some patients will have severe abdomen ache, like acute abdomen; dyspnea willappear on some cases if edema appear at respiratory tract; in few cases it may accompanied by septicemia while the patients have high fever, shivering with cold or fear. 2. Chronic urticaria Daily episodes of urticaria and/or angioedema lasting more than 6 weeks is designated chronic urticaria, which predominantly affects adults and is twice as common in women as in men. General symptoms of chronic urticaria are mild, more wheals or a few wheals, it will recur repeatedly, keeping for several months or years, it will sharpen in special time or not. Causes cannot be found in many cases. 3. Dermatographism Dermatographism is also known as factitious urticaria and is a sharply localized edema or wheal with a surrounding erythematous flare occurring within seconds to minutes after the skin has been scratched. (picture3,4) 4. Cholinergic urticaria Cholinergic urticaria is produced by the action of acetylcholine on the mast cell, characterized by minute, highly pruritic, punctate wheals or papules. Lesions persist 30 to 90 minutes and are followed by a refractory period up to 24 hours. It may be induced in the susceptible patient by exercise, emotional stress, increased environmental temperature, or intradermal injection of nicotine picrate or methacholine. 5. Solar urticaria It is always induced by media or longultraviolet ray, and appears soon on unshielded skin when exposed to sunlight. It is classified by the wavelengths of light that precipitate in the reaction. 6. Pressure urticaria It is characterized by the development of swelling with pain that occurs 4 to 6 hours after local area being pressed. There may be a latent period of as much as 24 hours before lesions develop. 7. Angioedema It always occur at rarefaction areas, like eyelid, lip, external genital organs, hand and foot. It appears abruptly, and shows localized edema features, it will diminish after 1 to 3 days. If angioedema appears at mucosa of larynx, it cancause dyspnea, even death. (picture5,6) Diagnosis The diagnosis of urticaria can be made upon its typical clinical manitestations, in details: wheals; fast appearing and diminishing; no trace after diminishing and specialties at every phase. It can be diagnosed easily, but cause-diagnosis are very difficult in many cases. Systemic treatment 1. Acute urticaria The mainstay of treatment of acute urticaria is administration of antihistamines. Vitamine C can also be used to decrease permeabilities of vessels. 654-2 or other same sorts of drugs can be chosen in acute urticaria followed by abdomenache. If it were accompanied by infection of bacteria, appropriate antibiotics therapy would be 15 分钟 4 分钟 2 分钟 2 分钟 2 分钟 1 分钟 1 分钟 3 分钟 2 分钟 9 分钟 2 分钟
necessary.3分钟shock or laryngeal edema or dyspneaImmediate injection with 0.1% adrenalin at 0.5ml by subcutaneous part.Inspiring with oxygen.Intravenous injection with hydrocortisone at 0.2 to 0.3g in 500ml glucose.After about 15 minutes, 0.1% adrenalin at 0.5ml can be used again.0.2gaminophyllineis usedforcases with bronchospasm.2.Chronic urticaria2分钟Looking for the real reason is very important, and corticoid must be avoided.Administrationof antihistamines again andshould be taken on a dailybasisAntihistaminedrugsneedtobeusedmorethan1monthafterwhealsdisappear.Sometimes2 or 3 antihistamine being used together have good effectSideeffects1分钟The patient should be warned about driving an automobile because of the tendency fordrowsinessfollowinguseoffirst-generationantihistamines.the second-generation antihistamines (cetirizine, famotidine, loratadine, acrivastine, andazelastine)arebettertothesepatients.3. Special sorts of urticaria1分钟It is recommended to use drugs, which have antihistamine, anti-serotonin and anti-acetylcholine effects, like hydroxyzine and decloxizine is better to physical urticaria,cyproheptadine has good effect to cold urticaria and 654-2 can always acts on cholinergicurticaria.Optical treatment1分钟It can be treated with calamine lotion or diphenhydramine emulsion
necessary. shock or laryngeal edema or dyspnea Immediate injection with 0.1% adrenalin at 0.5ml by subcutaneous part. Inspiring with oxygen. Intravenous injection with hydrocortisone at 0.2 to 0.3g in 500ml glucose. After about 15 minutes, 0.1% adrenalin at 0.5ml can be used again. 0.2g aminophylline is used for cases with bronchospasm. 2. Chronic urticaria Looking for the real reason is very important, and corticoid must be avoided. Administration of antihistamines again and should be taken on a daily basis . Antihistamine drugs need to be used more than 1 month after wheals disappear. Sometimes 2 or 3 antihistamine being used together have good effect. Side effects The patient should be warned about driving an automobile because of the tendency for drowsiness following use of first-generation antihistamines. the second-generation antihistamines (cetirizine, famotidine, loratadine, acrivastine, and azelastine) are better to these patients. 3. Special sorts of urticaria It is recommended to use drugs, which have antihistamine, anti-serotonin and antiacetylcholine effects, like hydroxyzine and decloxizine is better to physical urticaria, cyproheptadine has good effect to cold urticaria and 654-2 can always acts on cholinergic urticaria. Optical treatment It can be treated with calamine lotion or diphenhydramine emulsion. 3 分钟 2 分钟 1 分钟 1 分钟 1 分钟
1. Urticaria is a very common disease and is a vascular reaction of the skincharacterized bythe appearanceofwheals,white orred evanescent plaquesgenerally surrounded by a red halo or flare and associated with severe itching,stinging,orprickingsensations.2.The clinical manifestations of urticaria is divided into 3 parts: acute urticaria,chronical urticaria and some special sorts of urticaria.3. The mainstay of treatment of acute urticaria is administration of antihistamines.小结4. The treatment of shock or laryngeal edema or dyspnea are: immediate injectionwith 0.1% adrenalin at 0.5ml by subcutaneous part.1.Howto deal with shock of acute urticaria?2. What is wheal?3.What are the most common causes ofurticaria?思考题及预习教案讲稿质量评价表
小结 1. Urticaria is a very common disease and is a vascular reaction of the skin characterized by the appearance of wheals, white or red evanescent plaques generally surrounded by a red halo or flare and associated with severe itching, stinging, or pricking sensations. 2. The clinical manifestations of urticaria is divided into 3 parts: acute urticaria, chronical urticaria and some special sorts of urticaria. 3. The mainstay of treatment of acute urticaria is administration of antihistamines. 4. The treatment of shock or laryngeal edema or dyspnea are: immediate injection with 0.1% adrenalin at 0.5ml by subcutaneous part. 思考 题及 预习 1. How to deal with shock of acute urticaria? 2. What is wheal? 3. What are the most common causes of urticaria? 教案讲稿质量评价表