Urticaria
What are urticaria ?
Urticaria (medically known as urticaria) appear on the skin as wheals which are red, very itchy, smoothly elevated areas of skin often with a blanched center. They appear in varying shapes and sizes, from a few millimeters to several inches in diameter anywhere on the body.
What causes urticaria ?
Urticaria are produced when histamine and other compounds are released from cells called mast cells, which are normally found in the skin. Histamine causes fluid to leak from the local blood vessels, leading to swelling in the skin.
Urticaria are very common. Although they can be annoying, they usually resolve on their own over a period of weeks and are rarely medically serious. Some urticaria are caused by allergies to such things as foods, medications, and insect stings, but in the majority of cases, no specific cause for them is ever found. Although patients may find it frustrating not to know what has caused their urticaria, maneuvers like changing diet, soap, detergent, and makeup are hardly ever helpful in preventing urticaria and are not necessary for the most part.
Having urticaria may cause stress, but stress by itself does not cause urticaria.
In rare cases (some hereditary, others caused by bee stings or drug allergy), urticaria and angioedema are accompanied by a striking decrease in blood pressure (shock) and difficulty breathing. This is called anaphylaxis. Ordinary urticaria may be widespread and disturbing to look at, but the vast majority of cases of urticaria do not lead to life-threatening complications.
What are the different kinds of urticaria?
Urticaria fall into two categories: acute urticaria (ordinary urticaria which resolve after six to eight weeks) and chronic urticaria (which continue longer than six to eight weeks).
Ordinary urticaria (ordinary urticaria)
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What are symptoms and signs of ordinary urticaria?
Ordinary urticaria flare up suddenly and usually for no specific reason. Welts appear, often in several places. They flare, itch, swell, and go away in a matter of minutes to hours, only to appear elsewhere. This sequence may go on from days to weeks. Most episodes of urticaria last less than six weeks. Although that cutoff point is arbitrary, urticaria that last more than six weeks are often called “chronic.”
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What are the causes of ordinary urticaria?
As noted above, many cases of ordinary urticaria are “idiopathic,” meaning no cause is known. Others may be triggered by viral infections. A few may be caused by medications, usually when they have been taken for the first time a few weeks before. (It is uncommon for drugs taken continuously for long periods to cause urticaria or other reactions.) When a medication is implicated as a cause of urticaria, the drug must be stopped, since no skin or blood test will prove the connection. In most cases, drug-induced urticaria will go away in a few days. If a drug is stopped and the urticaria do not go away, this is a strong indication that the medication was not in fact the cause of the urticaria.
Some medications, like morphine, codeine, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [Advil]), cause the body to release histamine and produce urticaria through nonallergic mechanisms.
Despite the reputation urticaria have for being “allergic,” when there is no obvious connection between something new that a person has been exposed to and the onset of urticaria, allergy testing is not usually helpful.
Chronic urticaria
Chronic urticaria (defined as lasting six weeks or more) can last from months to years. The evaluation of this condition is difficult and allergy testing and other laboratory tests are rarely useful in such cases. The accurate evaluation of this condition requires the patient to give his or her physician precise information regarding their complete medical history, personal habits, and oral intake. Occasionally it may be necessary to limit specific foods or drugs for a time to observe any affect upon the skin condition. Certain systemic disease and infections may occasionally present in the skin as urticaria. If there is an inciting cause that can be determined, then specific treatments for that condition ought to be effective, or in the case of food or drug allergy, strict avoidance would be necessary. There are additionally rare forms of chronic urticaria that are produced when the patient makes antibodies against molecules on the surface of their own mast cells. There are tests available to identify this type of urticaria.
Physical urticaria is a type of chronic urticaria produced by physical stimuli. By far the most common form is dermographism, which literally means “skin writing.” This is an exaggerated form of what happens to anyone when their skin is scratched or rubbed: a red welt appears at the line of the scratch. In dermographism, raised, itchy red welts with adjacent flares appear wherever the skin is scratched or where belts and other articles of clothing rub against the skin, causing mast cells to leak histamine.
Another common form of physically induced urticaria is called cholinergic urticaria. This produces hundreds of small, itchy bumps. These occur within 15 minutes of exercise or physical exertion and are usually gone before a doctor can examine them. This form of urticaria happens more often in young people.
Other forms of physical urticaria are much less common. Triggers for these include cold, water, and sunlight.
Are there other conditions that mimic urticaria?
There are other rashes that may look like urticaria but the fact that they remain stable and do not resolve within 24 hours is helpful in distinguishing them from urticaria. Such rashes may need to be biopsied (a small sample of skin is taken and examined under the microscope) to accurately determine the nature of the skin disease.
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