Urticaria

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CLINICAL DESCRIPTION

A very itchy skin disease characterized by pruritic wheals or hives. It is due to extravasation of fluid in the upper dermis. It is called angioedema if deep dermis and subcutaneous tissues are involved leading to massive swelling.

Classification of urticaria

  • Idiopathic
    • Can be acute: having symptoms lasting up to 6 weeks
    • Chronic: having symptoms lasting beyond 6 weeks
  • Physical
    • Urticaria that occur secondary to and external trigger e.g., heat, cold, pressure  

Note: Identifying a specific cause of urticaria is usually a challenge and often a futile task. Empirical treatment is encouraged in all cases

CLINICAL FEATURES

SIGNS AND SYMPTOMS
  • Wheals are the hall mark of the disease
  • Extreme pruritus but no excoriations are seen
  • Transitory nature with individual lesions lasting 1–24 hours
TREATMENT
  • Explain the condition to the patient
  • Remove the cause if known
  • Desist from giving medications for the duration of symptoms only and stopping immediately after they disappear.
  • Give antihistamines for a set period as outlined below:
    • Give Promethazine 25mg orally at night till 2 weeks after submission of the wheals.
    • In so doing, antihistamines may need to be given for several months to effectively control the disease.
  • Alternatively
    • Give Chlorpheniramine 4-8mg at night or 8 hourly until two weeks after eruption of wheals.
    • Give (alternatively) Cetirizine 5-10mg daily until two weeks after lesions clear.
    • Apply Calamine lotion at night or 12 hourly

For tracheal angioedema

  • Give Adrenaline 0.5mg stat dose sub-cutaneously in severe urticaria with tracheal angioedema

Red Flags

  • If it is angioedema, refer.