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Urticaria

Urticaria, commonly known as hives, is a vascular reaction of the skin characterized by raised, itchy welts. It can be acute, lasting less than 6 weeks, or chronic, persisting over 6 weeks. Urticaria has many causes, including drugs, foods, infections, stress, and physical stimuli. Histamine and other inflammatory mediators are responsible for the skin reaction and itching. Treatment focuses on identifying and avoiding triggers, and includes antihistamines, corticosteroids, mast cell stabilizers, and immunosuppressants in severe cases. Proper diagnosis involves examination, patient history, and tests to rule out other conditions.

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54 views21 pages

Urticaria

Urticaria, commonly known as hives, is a vascular reaction of the skin characterized by raised, itchy welts. It can be acute, lasting less than 6 weeks, or chronic, persisting over 6 weeks. Urticaria has many causes, including drugs, foods, infections, stress, and physical stimuli. Histamine and other inflammatory mediators are responsible for the skin reaction and itching. Treatment focuses on identifying and avoiding triggers, and includes antihistamines, corticosteroids, mast cell stabilizers, and immunosuppressants in severe cases. Proper diagnosis involves examination, patient history, and tests to rule out other conditions.

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Sumon Ghosh
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Lecture

on
Urticaria
Prof. Dr. Md. Abu Yousuf Bhuiyan
Professor of Dermatology
Sylhet MAG Osmani Medical College
• Definition:-
• It is a vascular reaction of the skin
characterized by the appearance of wheal,
white or red evanescent plague, generally
surrounded by a red halo or flare &
associated with severe itching, stinging or
pricking sensation.
• Classification: (a) Clinically- acute (within 6
weeks disappear)
Chronic- persist (>6 weeks persist)
(b) On the basis of pathogenesis:
1. Immunological- IgE dependent, type-1
hypersensitivity, complement mediate form
serum sickness.
2. Non immunological- a) Direct – opiate,
polymyxin, tubocuraine, radio contrast dye.
b) Indirect- Aspirin, NSAID, Tartazine,
Benzocaine
c) Mast cell degranulation
3. Idiopathic- More than 50% are idiopathic &
chronic
Etiology:
• Drug- penicillin, aspirin, salicylate, NSAID,
opiate, x-ray contrast, angiotensin converting
enzyme inhibitor.
• Food & food additives- Yeast, citric acid, egg,
fish albumin.
• Infections- Tooth, Tonsil, Sinus, Gall bladder,
Kidney, Prostate & Bladder.
• Others- Emotional stress, menthol, neoplasm,
inhalants, virus, parasite, alcohol.
• Physical stimuli- Produce 7-17% urticarial
reaction, dermographic, cold, heat, cholinergic,
aquagenic, solar, vibratory, exercise induced
urticaria.
Pathogenesis:
• Inflammatory mediators like histamin,
serotonine, slow reacting substance,
prostaglandin, protease, bradykinine &
various other kinine is responsible.
• Investigation: 1. Complete blood count,
2. eosionophilia, 3. stool for R/E, 4. urine
for R/E, 5. serum IgE, 6. x-ray chest, 7. x-
ray PNS, 8. ultrasonography, 9. thyroid
function test, 10. thyroid antibody, 11. liver
function test, 12. blood sugar, 13. hepatitis
B and C, 14. anti nuclear antibody, 15.
patch test, 16. provocative test, 17.
Histopathology.
• Differential Diagnosis:
1. Urticarial vasculitis
2. bullous pemphigoid
3. E.M.
4. granuloma anulare
5. sarcoidosis
6. T.cell lymphoma.
• Treatment modality: Treatment according to
cause
• Restriction of diet & avoidance of etiological
cause.
• Antihistamin of 1st generation eg.
diphenhydramine or hydroxyzine.
• Antihistamin+short course of prednisolone.
• Antihistamin+tricyclic anti depressant.
• Antihistamin H1+H2 blocker like cimitidine,
ranitidine.
• Mast cell stabilizer – ketotifen.
• Lekotriene receptor antagonist – montelukast.
• Anti pruritic lotion: Calamine lotion may eliminate
itching.
• Biologic e.g. omalizumab may effective.
• Calcium channel antagonist, mast cell stabilizer,
anti malarial, dapsone, azathropine,
methotrexate.
• Systemic corticosteroid .5 to 1mg/kg/day.
• Plasmapheresis, I/V immunoglobulin or
cyclosperine therapy.
Treatment of Acute Urticaria
• Assurance of the patient
• If Respiratory distress hospitalization
• Antibiotic like erythromycin 250/500mg 6 hourly or
inj. ceftriaxone BD
• Inj, Dexamethason (Roxadex) 6 hourly or 8 hourly
for 4-5 days than reduce according to response
• Antihistamine (Alatrol 10mg at night for 3 weeks)
• Mast cell Stabilizer (Tofen ,alarid) BD for 1 month.
• Antiulcerant like famotidin
Treatment of Chronic Urticaria
• Antibiotic like Azithromycin 500mg for 5 days
• Cetirizine 10mg at night ,Loratadin,fexofenadin,Bilastin
at morning.
• Mast Cell Stabilizer BD
• Montelukast at night
• Antihelminthic
• Ivermectin (Ivera 12mg stat and after 7 days)
• Motivation of the patient
THANK YOU

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