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Urticaria(Hives, Nettle rash or Weals)
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IntroductionClassification - acute
- chronicBrief pathophysiologyClinical presentationManagement
Angioneurotic edemaTypes of Angioneurotic edema
Purpura
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Urticaria vs Vasculitis
purpura
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URTICARIA
• Erythematous/edematous swelling
• Dermis• Transient• Usually associated
with itching
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Classification
• Acute (less than 6 weeks duration)
• Chronic (more than 6 weeks to 3 months)
• Immune complex urticaria
• Physical
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• Acute Urticaria(less than 6 weeks duration)
Drugs-Antibiotics- PenicillinTetracyclineCephalosporinSulphonamides
NSAIDSNeuropeptides, subs. PMorphine, codeineRadiocontrast Medium
Foods – StrawberriesCheeseChocolates
Idiopathic
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PathophysiologyType I hypersensitivity
Linkage of 2 adjacent IgE receptorson mast cell by Ag
Mast cell activation
Releases Histamine/mediators from receptors
Weals
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Clinical features
• Any age group
• Anywhere on body
• Itchy erythematous macules,weals(Pale,pink, oedematous, raised skin)
• Variable in numbersize shape (annular,serpiginous, bizarre)
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Acute Urticaria
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• Transient – last a few hours resolve within 24 hours
• On resolving skin is normal
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• Systemic complaintsMalaiseHeadache VomitingDiarrhoeaAbdomen pain ArthralgiaDizziness/syncope
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In children-- More acute
- Less itchy
- More tendency to purpura
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• May be assoc. with
angioedema
• Mucosal swelling
(angioedema)
– buccal mucosa,
tongue, pharynx
& larynx
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Chronic Urticaria
Weals present on most of days for a period
>6 weeks
Cause rarely identified
- Idiopathic
- Auto-immune
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Chronic Urticaria
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Provoking factors
- Drugs
- Penicillin, NSAID’s
- Foods/food additives
- Infection
- Dental
- Inhalants
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Systemic Diseases
-Collagen vascular diseases-Thyroid DS-Sarcoidosis-Pregnancy-Psychological stress
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Natural History :
resolves in 6 weeks
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Management
-Explanation
-Non specific measures to provoking agents
- H1 Antihistamines-I Generation-II Generation
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ManagementResistant Cases
- Combination of H1& H2 antihistamines
- Oral steroids in severe cases
- Cyclosporine
- If laryngeal oedema – adrenaline
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Physical Urticaria
Physical stimulusHeat Cold Exercise
Reproducible wealingDermographism
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-Factitious urticaria involvingtriple response
- Young adults- Severe itching, more at night
TreatmentAntihistaminesPUVA
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Cholinergic Urticaria
• Small weals• With sweating
Increase in temp.EmotionGustatory
• In adolescence
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-
Angioneurotic oedema/Angioedema
Manifestation of urticaria
- Transient swellingDeeper dermissubcutaneous submucosal tissues
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-Any part
lips
eyelids
genitalia
-Sudden onset
-Itching usually absent
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Angioneurotic oedema
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-Lasts few hours to 2-3 days
-Treatment
Same as chronic urticaria
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ACE inhibitor induced Angioedema
After 3 weeks of treatment but can occur at any time during treatment
TREATMENT -Stop ACE inhibitor
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Hereditary Angioedema
Deficiency of natural inhibitor of C1 esterase
Rare AD transmission
Family history present
Onset childhood
Recurrent swellings
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Associated with nausea
vomiting
colic/urinary symptoms
TreatmentAndrogens/Anabolic drugs – Stanazolol
Fresh frozen plasma
Purified inhibitor
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Purpura
Discoloration of
skin /mucus
membranes due to
extravasation of
R.B.C
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Purpura
<2mm - petechiae
>2mm-ecchymosis
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Classification of purpura• Platelet disorders (Thrombocytopenia)
Defective productionDecreased survivalExcessive consumption
• Vascular or nonthrombocytopenicPhysical-coughingSenile ScurvyToxic purpura
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Clinical Classification
• Palpable
• Nonpalpable
Treatment-
Treatment of cause