Urticarial. Strophulus.
Urticaria also known as hives, is a recurrent transient cutaneous swellings and erythema due to fluid transfer from the vasculature to the dermis. The condition varies from minor cutaneous lesions to severe/life-threatening form called angioedema affecting the laryngeal area. Local sudden increase in capillary permeability is the common final pathway. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to one day before fading.
Angioedema is similar to hives, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours. It can be acute (lasting less than six weeks) or chronic (more than six). For most people with chronic urticaria, the cause is impossible to determine. In some cases, though, the cause may be thyroid disease, hepatitis, infection, or cancer.
- Hallmark of Urticaria: Rapid appearance of a transient erythematous, often itchy, raised plaque lesions. Lesions may be multiple and appear with alarming speed. (the more you scratch, they more appear).
- Varieties of urticaria - can be due to:
- a) Histamine liberating drugs – salicylates are the most common. Patients with urticarial should not take aspirin, codeine or morphine. They can use alternatives like paracetamol.
- b) Ingested food additives – yellow to orange colored drinks (Tartrazine group of dyes)
- c) Contact urticaria – lesions develop only on sites of contact (for example with dog hair or saliva)
- d) Physical urticaria – from pressure, heat, cold or sunlight.
- e) Urticaria and hereditary angioedema – rare condition; there’s a chemical defect in the complement pathway. Enzyme C1 esterase is missing.
- f) Related to general conditions – miscellaneous group; patients infested with parasites tend to develop urticarial, as well as those with bacterial infections and Lupus Thyrotoxicosis.
- g) Unknown or Identifiable causative factor – comprises the largest group of patients.
- Diagnosis – for cases of chronic persistent urticaria:
- Antinuclear Ab
- Complement screening C1 esterase INH
- Hot stool for parasites
- Urine for bacteria
- Chest and sinus x-ray
- Liver f(x) tests
- Full blood count (Hb, WBC, eosinophil count, platelets)
- Treatment: