What is the focus of the physical exam in patients with chronic urticaria?

Updated: Jul 31, 2018
  • Author: Marla N Diakow, MD; Chief Editor: William D James, MD  more...
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The typical lesion of urticaria is a pale-to-red, well-demarcated papule or plaque. Lesions may be round, oval, annular, arcuate, serpiginous, or generalized. They resolve without postinflammatory pigmentary changes or scaling. Examination should focus on the following:

  • Characteristics of primary lesions: These are edematous, erythematous papules or plaques with a pale center (wheal) and surrounding erythema (flare)

  • Distribution of lesions: Lesions can be localized or generalized

  • Color of lesions: Depending on background skin color, lesions may be pale to red

  • Differentiation of urticaria types: Stroking the skin firmly tests for symptomatic dermatographism; exercise testing can confirm cholinergic urticaria; application of a melting ice cube in a plastic bag for 5 minutes may be used to test for cold urticaria (10 min after removal the ice cube wheal response is assessed)

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