Angioedema: A reaction pattern of itchy skin
When the edema is located at a deeper level results in angioedema manifested as edematous plaques infiltrated touch larger than the hives. The most frequent location of angioedema is in eyelids, lips and genitals taking place in just a few hours and taking more than two days to go away. In angioedema there is no itching or burning and depending on the location of the edema it may show gastrointestinal symptoms such as abdominal pain, nausea, vomiting and diarrhea, respiratory symptoms such as runny nose, sneezing, dyspnea, dysphonia, and finally, cardiovascular symptoms such as tachycardia widespread vasodilation and hypotension. The rash is present alone in forty percent of cases and accompanied by angioedema in fifty percent of cases. Angioedema occurs only in the remaining ten percent of cases.
The diagnosis is always made by the clinic, and the skin lesions are easy to identify. In addition, self-limited course and the absence of residual lesions in the skin when the rash disappears help identify this process. In special cases a biopsy is necessary to complete the study. In these cases there is edema in the superficial dermal wheal and deep dermis or hypodermis in angioedema. In hives-vasculitis there is also an inflammatory involvement of vessels in the skin.
It is important to avoid the triggers if known. In addition, as a first step starts antihistamine, provided with medical control. In cases where the response is not adequate, the dose may be increased or join other antihistamines. Anti-H1 antihistamines are commonly used, alone or in combination with each other. If there is still no response, the diagnosis must be reconsidered. Corticosteroids should be used only in the anaphylactic shock and pressure hives as a rebound effect associated with neglect in acute hives. Yet many pictures of hives are rebels to standard treatment and should be used other types of drugs that often require hospitalization. It is very important to assess the presence of associated respiratory distress and, if important, or not responding to previous treatments, the patient should be given subcutaneous epinephrine. In these cases it is necessary to resort to a doctor in a hospital.
In 90 percent of patients with acute hives, the hives stay for two or three weeks until full and final disappearance. Patients with chronic hives, recurring outbreaks can continue for long. In these cases require further study to rule out possible triggers.
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