Urticaria, commonly referred to as hives, is
the most frequent dermatologic disorder. Medically, urticaria may be
defined as skin eruption, which is allergic (or non-allergic) in origin
and is characterized by profound itching, red circular or irregularly
shaped eruptions on any part of the body.
It is estimated that 5% of all people will develop urticaria at some
point in their lives. Hives are more common in women than in men. Of
those with chronic hives (those lasting six weeks or more), some 80%
are idiopathic, the medical term which means that no cause, allergic or
otherwise, can be found.
Cause-
The cause of acute generalized urticaria often is undetermined (some
sources report that the cause is undetermined in more than 60% of
cases). Known causes include the following:
Infections (eg, pharyngitis, GI infections, genitourinary infections,
respiratory infections, fungal infections [eg, dermatophytosis],
malaria, amebiasis, hepatitis, mononucleosis, coxsackievirus,
mycoplasmal infections, infestations [eg, scabies], HIV, parasitic
infections [eg, ascariasis, strongyloidiasis, schistosomiasis,
trichinosis])
Foods (particularly shellfish, fish, eggs, cheese, chocolate, nuts,
berries, tomatoes)
Drugs (eg, penicillins, sulfonamides, salicylates, NSAIDs, codeine,
antihistamines)
Environmental factors (eg, pollens, chemicals, plants, danders, dust,
mold)
Exposure to latex
Exposure to undue skin pressure, cold, or heat
Emotional stress
Exercise
Pregnancy (ie, pruritic urticarial papules and plaques of pregnancy
[PUPPP])
Chronic urticaria can be related to all of the above as well as to the
following:
Autoimmune disorders (SLE, rheumatoid arthritis, polymyositis, thyroid
autoimmunity, and other connective tissue diseases); probably up to 50%
of chronic urticaria is autoimmune.6
Cholinergic urticaria induced by emotional stress, heat, or exercise
(Examine for other signs of cholinergic stimulation including
lacrimation, salivation, and diarrhea.)
Chronic medical illness, such as hyperthyroidism, amyloidosis,
polycythemia vera, malignant neoplasms, and lymphoma
Cold urticaria, cryoglobulinemia, cryofibrinogenemia, or syphilis
Mastocytosis
Muckle-Wells syndrome
Familial cold autoinflammatory syndrome
The etiology of chronic urticaria is undetermined in at least 80-90% of
patients.
Urticaria pigmentosa is a familial dermatologic disorder characterized
by hyperpigmented (yellow, tan, or brown) papules or plaques that may
be associated with lymphoproliferative disorders. These lesions are
composed of mast cells. When the skin overlying an individual lesion of
urticaria pigmentosa is stroked, a linear wheal is formed; this
characteristic and diagnostic sign is known as the Darier sign.
Recurrent urticaria can be related to the following:
Sun exposure (solar urticaria, occurring only on skin exposed to the
sun)8
Exercise (cholinergic urticaria)
Emotional or physical stress
Water (aquagenic urticaria)
Symptoms-
The clinical presentation of urticaria is usually acute or
acute-on-chronic or recurring.
The patient may present with usually sudden, acute skin eruption with
swelling, redness, intense itching, burning and anxiety. . Most
episodes of hives last less than six weeks. Although that cutoff point
is arbitrary, hives that last more than six weeks are often called
"chronic."
The eruptions may be irregularly shaped or round or may be like
vertical lines. They may appear single or multiple, occasional or many
appearing at once or a appearing and disappearing in random order.
It is associated with intense itching which, when uncontrolled makes
the patient restless and impatient. At times, the eruptions and itching
may lead to disturbance at work and sleeplessness.
Angieodema- Swelling deeper in the skin that may accompany hives is
called angioedema. This may be seen on the hands and feet as well as on
mucous membranes (with swelling of the lips or eyes. Urticaria and
angioedema sometimes occur together in response to an allergen and is a
concern in severe cases as angioedema of the throat can be fatal.
Investigations-
Laboratory Studies
For acute urticaria, laboratory studies generally are not indicated.
The patient's history and physical examination should direct any
diagnostic studies.
For chronic or recurrent urticaria, basic laboratory studies should
include a CBC, erythrocyte sedimentation rate, TSH and an ANA looking
for possible causes of the urticaria.
Imaging Studies
Imaging studies generally are not indicated unless a specific finding
on clinical examination or history suggests an underlying etiology that
may warrant further diagnostic studies.
Treatment-
The goal of treating most cases of ordinary urticaria is to relieve
symptoms while the condition goes away by itself.
Most treatment plans for urticaria involve being aware of one's
triggers, but this can be difficult since there are several different
forms of urticaria and people often exhibit more than one type. Also,
since symptoms are often idiopathic (unknown reason) there might not be
any clear trigger. If one's triggers can be identified then outbreaks
can often be managed by limiting one's exposure to these situations
along with the medications.
Role of homoeopathy-
Homoeopathy offers an effective & permanent solution to
Urticaria. In homoeopathy, the treatment plan is so designed that it
corrects the natural healing processes, in turn treating Urticaria
from within.
Treatment is directed towards signs & symptoms, total
symptomatology, constitution of the patient, the causation etc.
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