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General Medicine

Urticaria

Todd A. Wical, DO and Katie L. Westerfield, DO, IBCLC, FAAFP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A cutaneous lesion or lesions involving edema of the epidermis and/or dermis presenting with rapid onset and pruritus, returning to normal skin appearance within 24 hours

  • Pathophysiol...

DIAGNOSIS

HISTORY

Rapid onset; individual lesions resolve in <24 hours, pruritus 
ALERT

Important to rule out underlying anaphylaxis in those patients presenting with acute onset of urticaria (1),(2)[...

TREATMENT

ISSUES FOR REFERRAL

Referral to an allergist, immunologist, or dermatologist for recalcitrant cases, especially if lesions consistently remain present for >24 hours 

GENERAL MEASURES

The mai...

ONGOING CARE

PROGNOSIS

  • Resolution of acute symptoms: 70% <72 hours

  • Chronic urticaria: 35% symptom-free in a year; another 30% will see symptom reduction.

REFERENCES

1
Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Aller...

ADDITIONAL READING

  • Maurer M, Weller K, Bindslev-Jensen C, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy.  2011;66(3):317–330. [View Abstract on...

CODES

ICD10

  • L50.9 Urticaria, unspecified

  • L50.1 Idiopathic urticaria

  • L50.8 Other urticaria

  • L50.2 Urticaria due to cold and heat

  • L50.6 Contact urticaria

  • L50.0 Allergic urticaria

  • L50.5 Cholinergic urticaria

  • L50....

CLINICAL PEARLS

  • Urticaria occurs rapidly and individual lesions resolve within 24 hours, although multiple crops of lesions can occur in stages.

  • Mainstay of therapy is to avoid identified triggers.

  • Anti...

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Related Images
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Urticaria - child with 2 day of itching, evanescent eruption
Urticaria - child with 2 day of itching, evanescent eruption
FIGURE 7.18 Urticaria. Dermal vasodilatation occurs, with no epidermal change (scale).
FIGURE 7.18 Urticaria. Dermal vasodilatation occurs, with no epidermal change (scale).
(A, B) Urticaria lesions are erythematous and irregular. Urticaria may be a manifestation of a more generalized anaphylaxis, but when the pathology is limited to the skin, the patients appear otherwise well.From Fleisher GR, MD, Ludwig S, MD, Baskin MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.
(A, B) Urticaria lesions are erythematous and irregular. Urticaria may be a manifestation of a more generalized anaphylaxis, but when the p...
Urticaria. Multiple lesions have various shapes and sizes. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Urticaria. Multiple lesions have various shapes and sizes. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis an...
Acute urticaria. Lesions are annular, arciform, and polycyclic, with bizarre shapes. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Acute urticaria. Lesions are annular, arciform, and polycyclic, with bizarre shapes. From Goodheart HP. Goodheart's Photoguide to Common Sk...
Urticaria. Marked angioedema is noted. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Urticaria. Marked angioedema is noted. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Ed...
Dermatographism (“skin writing”). These lesions occurred 3 minutes after stroking with the wooden tip of a cotton swab. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Dermatographism (“skin writing”). These lesions occurred 3 minutes after stroking with the wooden tip of a cotton swab. From Goodheart HP. ...
Cold urticaria. The “ice cube test.” Before (A) and 5 minutes after (B) application of an ice cube. A large wheal and surrounding erythema have appeared. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Cold urticaria. The “ice cube test.” Before (A) and 5 minutes after (B) application of an ice cube. A large wheal and surrounding erythema ...
dermatographism - early wheel and flare response following 'drawing' with a wooden swab
dermatographism - early wheel and flare response following 'drawing' with a wooden swab
dermatographism - 1 minute after previous photo
dermatographism - 1 minute after previous photo
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