Urticaria: For Health Officer Students Solomon H (MD, DVR)

URTICARIA
FOR HEALTH OFFICER STUDENTS

SOLOMON H ( MD, DVR )
INTRODUCTION
 is a heterogeneous group of diseases with a characteristic
skin lesions consisting of a wheal-and-flare reaction in
which localized intracutaneous edema (wheal) is
surrounded by an area of redness (erythema) that is
typically pruritic
 Individual attacks can last from as briefly as 30 min-36 hrs
 Can be as small as a mm to 6 or 8 inches in diameter

 A weal is a transient, well demarcated, pink or pale swellings of
the superficial dermis due to reversible exudation of plasma in
the skin
 Flare - erythema
Angio‐oedema is deep swellings of the dermis, subcutaneous or

submucosal tissues
 They are usually painful, rather than itchy,
 poorly defined and skin coloured
 usually last longer than weals.
Anaphylaxis is a sudden, severe, life‐threatening, systemic

reaction
EPIDEMIOLOGY
 is a world wide problem and can be seen at any age
 Generally more common in females than males but the

ratio varies with different type of urticaria
ETIOLOGY
PATHOGENESIS
 Although other cells are involved , mast cells are the
major effector cells in most forms of urticaria and
angioedemas
 They express high-affinity IgE receptors (FcεRI) and are
therefore capable of participating in IgE-dependent
allergic reactions
CLINICAL FEUTURES
CLINICAL FEATURES
 are recurrent wheals that are usually pruritic , pink- to-
red edematous plaque that often have pale center
 Wheals.……..are transient
.…………last usually < 24 hours
………….range from few mm- large cm
………….can become confluent and form plaque
CONT…
 Wheals with white-to-
light-pink color in the face
in a close-up view
 These are the classic

lesions of urticaria
 It is characteristic that
they are transient and
highly pruritic.
CONT…
 Small and large wheals
with erythematous
borders and a lighter color
centrally
 Well-defined
 The lesion on the left

upper arm is ill-defined at
its lower border where it
is regressing.
CONT…
CLASSIFICATION
A. Acute Urticaria- When urticaria is present

daily or almost daily for less than 6 weeks
B. Chronic Urticaria- If urticaria occurs

continuously on most days and persisting
beyond 6 weeks and are divided into two
major subgroups,
1. Chronic Autoimmune Urticaria (45 %) and
2. Chronic Idiopathic Urticaria (55%)
CONT…
CONT…
 ‘ordinary urticaria’- It refers to the usual presentation of
continuous urticaria and used when other patterns of
urticaria have been excluded
Acute urticaria
 All urticarias are initially acute (20% - 30% progress to chronic

urticaria)
 urticaria is present daily or almost daily for less than 6 weeks
 is common in young children with atopic dermatitis

CONT….
CONT…
Chronic urticaria
 urticaria occurs continuously on most days for longer than

6 weeks at least twice a week off treatment.
 peaks in the fourth decade.
 Angioedema occurs in up to 40% of patients

CONT…
CONT…
 Aggravating factors in chronic ordinary urticaria (often
more than one)
 Aspirin and other NSAID

 Dietary pseudo allergens
 Upper respiratory tract infections
 Pressure
 Overheating
 Premenstrual period in women
 Alcohol
 Stress
DIFFERENTIALS
 Papular urticaria
 Erythema multiforme
 Pre-bullous pemphigoid
 Acute contact dermatitis
 Sweet's syndrome
 Pruritic Urticarial Papules And Plaques Of Pregnancy (PUPPP)
 Urticarial drug reaction

DIAGNOSIS
 A detailed history and a thorough P/E is important
History should include
 Duration of disease,
 Frequency of attacks,
 Duration of individual lesions,
 Previous treatment,
 Known adverse reaction,
 Impact of the disease on the patient's quality of life
CONT…
Physical examination
 Morphology and duration (by circling individual lesions)

of wheals,
 Signs of systemic disease
 The patient's own photographs - useful since it is common

for urticaria to have cleared by the time of consultation.
APPROACH
TREATMENT
General measures
 Patients education
 Nonspecific aggravating factors, should be minimized e.g.

overheating, stress, alcohol and drugs with the potential
to worsen urticaria ( aspirin and codeine)
 Avoid triggers
 Cooling antipruritic lotions such as 1% or 2% menthol in

aqueous cream or calamine lotion
CONT…
 PHARMACOLOGICAL
1. First line (antihistamines)
2. Second line (targeted treatments)
3. Third line (immunomodulatory)

FIRST LINE THERAPIES
 Antihistamines are the mainstay of treatment
 Should be taken on a daily basis, (not only when the
patient is symptomatic)
 Grouped
 First-generation (classic)
 Second-generation (non or minimally sedating)
 The H2 antagonists
;-Combining drugs from the different groups show a

better control.
CONT…
CONT…
PROGNOSIS
 Among patients with Chronic urticaria
 Approximately 50 % of patients are free of lesions within 1

year,
 65% within 3 years,
 85 % within 5 years
 Fewer than 5 % have lesions that last for more than 10 yrs
 only 25 % of pts who also have angioedema experience

resolution of lesions within 1 yr
THANK YOU

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URTICARIA

FOR HEALTH OFFICER STUDENTS

 Individual attacks can last from as briefly as 30 min-36 hrs

 Can be as small as a mm to 6 or 8 inches in diameter

Angio‐oedema is deep swellings of the dermis, subcutaneous or

Anaphylaxis is a sudden, severe, life‐threatening, systemic

 Generally more common in females than males but the

 These are the classic

 The lesion on the left

A. Acute Urticaria- When urticaria is present

B. Chronic Urticaria- If urticaria occurs

 All urticarias are initially acute (20% - 30% progress to chronic

 urticaria is present daily or almost daily for less than 6 weeks

 is common in young children with atopic dermatitis

 urticaria occurs continuously on most days for longer than

 peaks in the fourth decade.

 Angioedema occurs in up to 40% of patients

 Aspirin and other NSAID

 Acute contact dermatitis

 Pruritic Urticarial Papules And Plaques Of Pregnancy (PUPPP)

 Urticarial drug reaction

History should include

 Morphology and duration (by circling individual lesions)

 Signs of systemic disease

 The patient's own photographs - useful since it is common

 Nonspecific aggravating factors, should be minimized e.g.

 Cooling antipruritic lotions such as 1% or 2% menthol in

1. First line (antihistamines)

2. Second line (targeted treatments)

3. Third line (immunomodulatory)

;-Combining drugs from the different groups show a

 Approximately 50 % of patients are free of lesions within 1

 65% within 3 years,

 only 25 % of pts who also have angioedema experience

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