Classification and Treatment of Urticaria: A Brief Review

Kjetil Kristoffer Guldbakke, MD; Amor Khachemoune, MD, CWS


Dermatology Nursing. 2005;17(5):361-364. 

In This Article

Physical Urticarias

The physical urticarias are a distinct subgroup classified and induced by a physical stimulus. Most of these urticarias occur within minutes of provocation, and resolve within 2 hours, with the exception of delayed-pressure urticaria and dermographism which may persist for 24 hours or longer. Angioedema may occur in all the physical urticarias except dermographism. Overlap between groups is common, and they often occur as an added feature of chronic urticaria.

The most common type is simple-immediate dermographism, presenting with linear wheals at sites of scratching or friction, occurring in about 5% of the population. Lesions can be reproduced by scratching the skin, and usually resolve within 2 hours.

Delayed-pressure urticaria is a response to sustained pressure to the skin, presenting with deep erythematous swellings after a delay of 30 minutes to 12 hours of unknown cause. Swellings are usually pruritic or painful, and may persist for several days.

Cholinergic urticarial lesions occur within 15 minutes of sweat-inducing stimuli such as physical exertion, hot bath, alcohol, or sudden emotional stress. Small symmetrical wheals surrounded by an obvious flare, usually extends from the neck to the thighs, but any region may be involved. Young adults are mainly affected, and 50% have an atopic tendency (Greaves, 2000).

Cold urticaria is a heterogeneous group in which whealing occurs within minutes in response to cold exposure. Wheals usually arise at the site of localized cooling, but may also be generalized following lowering of the body temperature. In 5% of patients a serum abnormality called cryoglobulinemia can be identified, accounting for the secondary cold urticarias. Wheals are more persistent, lasting more than 24 hours, and may show features of vasculitis. This finding should lead to investigation for an underlying cause, such as hepatitis C or B infection, lymphoproliferative disease, or infectious mononucleosis. Other types of physical urticaria include vibratory angioedema, solar urticaria, and aquagenic urticaria.


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