The first affiliated hospital of zhengzhou univerThe first affiliated hospital of zhengzhou universitysity

subject Dermatology and venerology grade Oversea student

Dept. of DermatologThe First Affiliated Hospital of Zhengzhou University

Teaching way multimedia class hour 2

content Urticaria

Objective To master the clinical features, diagnosis and treatment of urticaria and angioedema

Key coceptAngioedema, previously called angioneurotic edema (giant urticaria) is an acute, evanescent, circumscribededema that usually affects the most distensible tissues or mucous membranes

Urticaria

Miao Qing

Department of dermatology

the First teaching hospital , Zheng Zhou university

Course of Dermatology

UrticariaUrticariaConcept

– Urticaria is a vascular reaction of the skin, characteriz

ed by the appearance of wheals, white or red evanes

cent plaques . It is associated with severe itching ,stingi

ng, or pricking sensations.

– In serious cases , it may target gastrointestinal and res

piratory tracts, resulting in abdominal pain , asthma a

nd respiratory problems.

Etiologic factorsEtiologic factors Drugs eg. Penicillin and related antibiotics, aspirin

Food eg. eggs, milk ,meat, chocolate ,cheese, nuts, peanuts, strawberries,tomatoes ,melons,onions and so on;

Infections eg. viruses 、 bacteria, parasites.

Food additives eg. yeast,azo dyes.

Physical factors eg. cold 、 heat 、 sunlight 、 pressure.

Systemic diseases eg. SLE 、 carcinoma

Mental factors eg. emotional stress

– Acute urticaria ( <6 weeks)

– Chronic urticaria( >6 weeks)

ClassificationClassification

PathogenesisPathogenesis

– Type allergyⅠ ： the most common– Type allergyⅡ– Type allergyⅢ

– Histamine releaser : aspirin

Immu-nologic

Non-immunologic

Acute urticariaAcute urticaria Clinical features

– they develop quickly and disappear quickly too.

– evanescent wheals last for < 12 h, the whole duratio

n is within 6 weeks

– the wheals may occur in any area of the body.

– mucosal surfaces can also be involved, with related

symptoms including respiratory distress, abdomina

l pain and hoarseness.

– it is serious when occuring on the larynx.

– urticarial lesions are usually pruritic and stinging

Clinical features

wheals ，red or pink

oval or irregular

various sizes

discrete or coalesce

severe itching

Chronic urticariaChronic urticaria

the skin lesions are the same as acute urticaria

the wheals happen frequently, mild or severe

the whole duration often evolves over months to years

the causes are very complicated

Physical urticariasPhysical urticarias

dermatographia(factitious urticaria ）

pressure urticaria

cold urticaria

– familial

– acquired

cholinergic urticaria

DermatographiaDermatographia

Clinical features:– it is a sharply localized edema or wheal with a surro

unding erythematous flare occuring within seconds

to minutes after the skin has been stroked.

– A provocative test is performed with a blunt-tipped

object by stroking the skin and observing for a linear

wheal.

– It can arise alone or arise spontaneously after drug-i

nduced urticaria and persist for months.

dermatographia

(facititious urticaria)

linear wheals which is accordant with stroke traces

pruritus

may arise alone or spontaneously after drug-induced urticaria

Cold urticariaCold urticaria

Concept

– exposure to cold may result in edema and whealing

on the exposed areas, usually the face and hands.

– It is classified into two types : acquired and familial

cold urticaria.

Pressure urticariaPressure urticaria

Pressure urticaria is characterized by the development of

swelling with pain that occurs 3 to 12h after local pressure h

as been applied.

It occurs most frequently on the feet after walking and on th

e buttocks after sitting.

The pain and swelling last for 8 to 24h.

Pressure urticaria

caused by localized pressure

swelling with pain

last for 8-24h

often happen on feet and

buttocks

DiagnosisDiagnosisClinical features

– skin lesions are wheals

– they occur quickly, vanish quickly too

– evanescent wheals last for < 12h, the complete resolu

tion is within 6 weeks (acute urticaria)

– severe pruritus

– in some cases , it may have systemic symptoms

TreatmentTreatment Acute urticaria

– antihistamines The first-generation H1 antihistamines Chlorpheniramin

e ( 4~8mg tid) Diphenhydramine (Benadryl 20mg im qd

), Promethazine(phenergan 25mg tid) ; ketotifen(1mg, b

id)

The second-generation H1 antihistamines

Astemizole (10mg qd), cetirizine(10mg qd),loratadine(10

mg qd), terfenadine(60mg bid)

TreatmentTreatment

Acute urticaria– systemic corticosteroid

Prednisone Dexamethasone (5~10mg,im)

– topical therapy topical steroids , eg. Previsone cream, Eloson .

topical antihistamine

TreatmentTreatment Chronic urticaria

– antihistamines The first-generation H1 antihistamines The second-generation H1 antihistamines

combination of H1 and H2 antihistamine

– In general , systemic corticosteroid medications

should be avoided .

AngioedemaAngioedema Concept

– Angioedema , previously called angioneurotic edema (giant u

rticaria) is an acute, evanescent, circumscribed edema that us

ually affects the most distensible tissues or mucous membrane

s.

– It is divided into two types: Acquired angioedema and Heredi

tary angioedema.

EtiologyEtiology

– Acquired angioedema caused by drugs 、 food 、 inhalants and physica

l factors lack of family history

– Hereditary angioedema inherited in an autosomal dominant fashion serum C1 cholinesterase( ChE) inhibitor deficien

cy or dysfunction

Acquired angioedema

happen in loose tissues （ eyelids 、 lips 、 external genitals ）

single

circumscribed edema

disappear within 1-3days

It is very serious when occuring in laryngeal

Hereditary angioedema

rarely ， family history

happen after trauma

occur in face and limb

lesion is non-pruritic edema

disappear within 1-3days ，recur easily

it is a medical emergency when happen on laryngeal

DiagnosisDiagnosis

– Often occur in the eyelids 、 lips 、 lobes of the ears 、 external genitals and mucous membranes of mouth,

tongue and larynx

– acute , circumscribed 、 evanescent edema,

often disappear within 1-3days

– often begin during the night and found on awakening

– low level of serum C1 esterase inhibitor or deficiency

Treatment Treatment Acquired angioedema

– the same as general urticaria

hereditary angioedema

– fresh frozen plasma

– danazol

– stanazol

– tranexamic acid

Papular urticariaPapular urticaria

concept

– a common disease ,often occur in children . Its skin l

esions are papules or wheals.

etiology– parasites bite ， eg.mosquito 、 flea 、 mite 、 punkie 、 b

ug

– allergic food induced

– abnormal gastrointestinal function

Papular urticariaPapular urticariaClinical features

– often happen in children – skin lesions are papules or wheals ， 0.5-2cm in size ，

typical lesions look like spindle

– it could generate blister in the center of lesion

– distribution :small distribution :small pruritic papulespruritic papules are mostly on the ar are mostly on the ar

ms and legs , but also occur on the face , the neck and thms and legs , but also occur on the face , the neck and th

e trunk.e trunk.

– about 1 week duration

Papular urticaria

often occur in children

papule or hive, often last for 1 week

blister 、 bulla in the ce

nter of lesions

caused by parasites sting or food

severe itch

DiagnosisDiagnosisClinical features

– often happen in children – skin lesions are papules or wheals ， 0.5-2cm in siz

e ， typical lesions look like spindle

– distribution :small pruritic papules are mostly on thdistribution :small pruritic papules are mostly on th

e arms and legs , but also occur on the face , the nece arms and legs , but also occur on the face , the nec

k and the trunk.k and the trunk.

– about 1 week duration

Treatment Treatment general treatment

– allergenic food should be avoided– elimination of the insects.

topical therapy– topical steroids, eg. Pevisone cream, Mometasone fu

roate cream (Eloson)– topical antipruritic lotions

Antihistamines– eg.chlorpheniramine , astemizole 、 cetirizine 、 ke

totifen, loratadine

Review and Summary

Clinical features

wheals ， red or white

oval or irregular

various sizes

evanescent hive

last for<12h

severe itching

wheals

dermatographia

(facititious urticaria)

clinical features:

linear wheals which is accordant with stroke traces

pruritus

may arise lonely or arise spontaneously after drug-induced urticaria

Pressure urticaria

clinical features

caused by localized pressure

swelling with pain

last for 8-12h

often happen on feet and

buttocks

Papular urticaria

clinical features

skin lesions:

papule or hive, often last for 1week

distribution alone

caused by parasites sting or food, often occur in children

severe pruritus

Acquired angioedema

clinical features

happen in loose tissues （ eyelids 、 lips 、 external genitals ）

single

circumscribed edema

disappear within 1-3days

It is very serious when occuring in laryngeal

Hereditary angioedema

clinical features

rarely seen ， has family history

happen after trauma

occur in face and limb

lesion is non-pruritic edema

disappear within 1-3days ，recur easily

serious when happen on laryngeal

Good-bye