urticaria wheal hives

1. URTICARIA
CLINICAL FEATURES
S.SHALINI
FINAL YEAR STUDENT

3. URTICARIA
• Is a heterogenous group of disorders characterised by itchy wheals ,
which develops due to evanescent oedema of dermis ( and
sometimes of subcutis).

6. Typical wheal or
hive .Oedema
and erythema is
also seen .

7. Hive or wheal

8. • Urticaria of the forearm

9. CLINICAL FEATURES
SYMPTOMS
• Itching is prominent , especially if wheals are superficial.
• However patient tend to rub rather than scratch their lesion , so
scratch marks are not seen.
GENERAL FEATURES :

10. Pale , pink , edematous
wheals with surrounding
flare

11. MORPHOLOGY
• Lesions begin as erythematous macules ,
which rapidly evolve into pale pink
edematous WHEALS with surrounding
flare.
• Larger lesions may be annular with paler
centre.

12. Itchy pink wheals

13. EVOLUTION
• Wheals last a few hours and resolve within 24-48 hours leaving
behind normal skin.
• Individual hives can last from as briefly as 30 minutes to as long as 36
hours.
• Wheals of cholinergic urticaria subside within a few minutes.

14. NUMBER AND SIZE
• Number and size of wheals are variable.
• They can be as small as a millimeter or 6 to 8 inches in
diameter (giant Urticaria).
• Cholinergic urticaria a type of inducible or physical
urticaria is characterised by PIN POINT WHEALS.

15. SHAPE
• Shape can be circular , annular ,
arcuate, serpiginous or bizarre.
• Dermographic urticaria is characterised
by linear wheals.

16. Pale pink edematous
bizarre shaped
wheals with a
surrounding flare
Paler wheals

17. ANGIOEDEMA
• Half the patients with urticaria have associated episodes of
angioedema in which pale pink swellings occur especially on the face
affecting eyelids and lips and sometimes genitalia.
• May also be associated with swelling of tongue , pharynx , larynx,
(when the patient presents to the medical emergency ).
• Itching is minimal and the swelling may last for several days.

19. Pale , pink , swelling of the lips . May be
associated with swelling of tongue ,
pharynx and larynx .

20. Urticaria and angioedema.
This patient has
• urticaria occurring on the face, neck, and upper trunk with
• angioedema about the eyes.

21. Associated features
Urticaria may also be associated with systemic symptoms in the form of
• Malaise
• Fever
• Headache
• Abdominal pain
• diarrhoea
• vomiting
• Arthralgia
• dizziness
• syncope
• anaphylaxis ( with severe acute urticaria )

22. Type of urticaria Morphology
 Dermographic urticaria  Linear wheals
 Cholinergic urticaria  Small , very transient wheals
 Cold urticaria  Small , large wheals
 Solar urticaria  Lesions on photo exposed parts
 Delayed pressure urticaria  Urticaria develops 3-6 hours after pressure . Lasts
for 12-72 hours.
 Buttocks (prolonged sitting),Hands (in manual
workers),Under Feet (prolonged walking) and
Waist (tight underclothes).

23. • Simply rubbing, scratching the skin promotes linear hives within
minutes.
• Typically is short-lived in duration (1/2 to 3 hours) and responds
readily to antihistamines.
• Linear wheals.

24. TRIPLE RESPONSE
• When the line is made by a pointed object ( like a key ) three
reactions are seen in succession.
• All these together are called TRIPLE RESPONSE and the reactions are
RED , FLARE , WHEAL.
• It was described by Lewis and is also called TRIPLE RESPONSE OF
LEWIS.
• It is produced due to the release of histamine from the mast cells.
• Urticaria is defined as a skin lesion consisting of a wheal-and-flare
reaction in which Iocalised intracutaneous edema (wheal) is
surrounded by an area of redness (erythema) that is typically pruritic.

26. • Topical dermatographic response to scratching
the skin.

27. Linear wheals at sites of scratching
Dermographic urticaria

28. • Small pruritic papules -
surrounded by erythema .
• Small , very transient wheals.
Cholinergic urticaria

29. Small very evanescent wheals
Cholinergic
urticaria

30. Small , large wheals
Cold induced urticaria

31. Solar urticaria

32. Delayed pressure urticaria
due to tight dressings

34. Contact urticaria due to
natural rubber latex
allergy

35. Contact urticaria from
caterpillar hairs

37. • World 🌎 Urticaria Day
• 1st OCTOBER
• Who cares? UCARE!

38. THANK YOU