Physical urticaria
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Physical urticaria is a distinct subgroup of urticaria (hives) that are induced by an exogenous physical stimulus rather than occurring spontaneously.{{cite book |last1=Rapini |first1=Ronald P. |title=Dermatology: 2-Volume Set |last2=Bolognia |first2=Jean L. |last3=Jorizzo |first3=Joseph L. |publisher=Mosby |year=2007 |isbn=978-1-4160-2999-1 |location=St. Louis |pages=265, 266, 267–268}} There are seven subcategories that are recognized as independent diseases.{{Cite journal|last=Beate|first=Henz|date=2000|title=Antihistamines and Alternatives in Physical Urticaria.|journal=Dermatologic Therapy}} Physical urticaria is known to be painful, itchy and physically unappealing; it can recur for months to years.{{Cite journal|last1=Martina|first1=Kozel|last2=Mekkes|first2=Jan|last3=bossuyt|first3=patrick|date=October 2001|title=Natural course of physical and chronic urticaria and angioedema in 220 patients|pmid=11511835|journal=Journal of the American Academy of Dermatology|doi=10.1067/mjd.2001.116217|volume=45|issue=3|pages=387–91}}
Signs and symptoms
Urticaria are characterized by dermal edema (wheal, swollen) and erythema (flare, red),{{Cite journal|last1=Lee|first1=Ernest E.|last2=Maibach|first2=Howard I.|date=February 2001|title=Treatment of Urticaria: An evidence-based evaluation of Antihistamines|journal=American Journal of Clinical Dermatology|volume=2|issue=1|pages=27–32|doi=10.2165/00128071-200102010-00005|pmid=11702618}}{{Dead link|date=May 2020 |bot=InternetArchiveBot |fix-attempted=yes }} also known as hives. Hive lesions typically last less than 24 hours and are usually itchy (pruritic). Hives can appear anywhere on the body and they may change shape, move around, disappear and reappear over short periods of time.{{Cite web |title=Hives (Urticaria) |url=http://acaai.org/allergies/types/skin-allergies/hives-urticaria |access-date=2016-04-24 |website=American College of Allergy, Asthma & Immunology}}
= Types of hives =
Acute urticaria (short-term): can develop suddenly and will last less than six weeks.{{Cite web |title=Hives (Urticaria): Causes, Symptoms, and Treatment |url=https://patient.info/skin-conditions/hives-inducible-urticaria |access-date=2023-09-26 |website=Patient UK}} About one in six people will have acute hives at one point in their life.
Chronic urticaria (long-term): can develop suddenly and will persist more than six weeks. This type of urticaria is uncommon and occurs in only 0.1% of the population.{{Cite journal |last=Katelaris |first=Connie |date=October 2001 |title=Treatment of Urticaria |url=https://australianprescriber.tg.org.au/articles/treatment-of-urticaria.html |journal=Australian Prescriber |volume=24 |issue=5 |access-date=26 September 2023}} 20% of people with chronic urticaria report still having problems 10 years after its onset.
Causes
The cause of physical urticaria is unknown but it has been suggested to be an autoimmune disease, suggesting that antibodies, which are produced by the immune system to protect humans from foreign microbes, are binding to body tissue and damaging it.{{Cite journal|last1=CL|first1=Goh|last2=Kt|first2=Tan|date=2009|title=Chronic Autoimmune Urticaria : Where We Stand ?|pmid=20161862|journal=Indian Journal of Dermatology|doi=10.4103/0019-5154.55640|volume=54|issue=3|pmc=2810697|pages=269–74 |doi-access=free }}
In some cases physical urticaria can be a symptom of an underlying health issue such as:{{Cite web|url=http://www.webmd.com/skin-problems-and-treatments/guide/hives-urticaria-angioedema|title=Hives and Your Skin|website=WebMD|language=en-US|access-date=2016-04-25}}{{Cite book |last1=Grattan |first1=Clive |title=Dermatology |last2=Black |first2=A. K. |publisher=Elsevier |year=2003 |isbn=9780323024099 |editor-last=Bolognia |editor-first=Jean |volume=1 |location=London |pages=287–302 |chapter=Urticaria and angioedema |editor-last2=Jorrizo |editor-first2=Joseph L. |editor-last3=Rapini |editor-first3=Ronald P.}}
Diagnosis
= Sub-categories =
There are seven sub-categories of physical urticaria:
- delayed pressure urticaria (DPU)
- cholinergic urticaria (ChU)
- cold urticaria (CU)
- solar urticaria (SU)
- acute pressure urticaria (AU)
- chronic idiopathic urticaria (CIU)
- symptomatic dermatographism urticaria (SDU) (most common)
Treatment
Antihistamine agents are the typically prescribed drug for the treatment of physical urticaria. They block the effect of histamine, a compound produced by the body which forms a part of the local immune response consequently causing inflammation. Some research has suggested that the use of antihistamines and antagonists in synergy are better for the treatment of physical urticarias.Breathnach SM, Allen R, Ward AM, et al. Symptomatic dermatographism: Natural history, clinical features, laboratory investigations and response to therapy. Clin Exp Dermatol 1983; 8 (5): 463-76Kaur, Surrinder, Malcolm Greaves, and Nahid Eftekhari. "Factitious Urticaria (dermographism): Treatment by Cimetidine and Chlorpheniramine in a Randomized Double-blind Study." Br J Dermatol British Journal of Dermatology 104.2 (1981): 185-90. Web.{{Better source needed|reason=Need review articles (also more recent ones)|date=September 2023}}
The cascade of events that link the autoantibody-antigen reaction with the production and release of histamine is not well characterized. Therefore, the focus of treatment for physical urticaria has been on characterizing the effectiveness of antihistamines rather than analysis of receptor binding or the pathomechanisms.