DOCSLIB.ORG

50 Practical Dermatology December 2008 Lucocorticosteroids Are a Mainstay in the Dermatol- Side Effects

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
50 Practical Dermatology December 2008 Lucocorticosteroids Are a Mainstay in the Dermatol- Side Effects 50 Practical Dermatology December 2008 lucocorticosteroids are a mainstay in the dermatol- side effects. However, menstrual irregularities often occur in ogist’s armamentarium. In fact, almost 90 percent premenopausal women who are not on anovulatory drugs. of dermatologists responding to a survey of the San This has been shown to be a result of suppression of cyclical Francisco Dermatologic Society in 1974 indicated gonadotrophins, leading to decreased estrogen and markedly Gthey used long-acting parenteral corticosteroids in low levels of progesterone.1 their practice, mostly the acetonide salt of triamcinolone Endometrial biopsies from such women show proliferative (TAC-A1). Despite the age of the survey, findings likely still changes, and spotting is believed to be due to low-estrogen reflect practice, as no reliable alternatives to glucocorticos- shedding. These occurrences are unique to TAC-A. Other teroids have emerged for the most common dermatologic injectables, such as betamethasone, methylprednisolone and indications. triamcinolone diacetate, do not have this effect and may be substituted but are less effective with much shorter durations TAC-A in the Clinic of action. Despite its popularity and its general safety and tolerability, Another predictable effect of TAC-A is suppression of the triamcinolone acetonide is associated with potential short- hypophyseal-pituitary-adrenal (HPA) axis. In studies of the comings. TAC-A is a suspension and must be shaken vigor- axis in patients treated with very high doses of TAC-A, there ously prior to injection. “Clumping” renders the product less remains some production of cortisol by the adrenals, and this effective, and irreversible clumping will occur with freezing. is assumed to be the reason that no adverse effects, such as Product information accompanying TAC-A is vague and fails Addisonian crisis, have been observed in patients on long- to outline a specific approach to long-term therapy of any term therapy. Still, suppression of the HPA axis persists for dermatologic disease. months after TAC-A is discontinued,2 and, therefore, the Using an example of chronic hand eczema in an atopic potential for Addisonian crisis exists. individual, 40mg of TAC-A is administered deeply in gluteal Capillary fragility with purpura on the dorsal forearms is muscle to avoid lipoatrophy at the injection site. If such a frequently observed in elderly patients and is accentuated in depression is created, it will take many months—up to 18— people with chronic sun damage or those taking aspirin or to return to normal. In some cases, the lipoatrophy never Coumadin. Posterior, subcapsular cataracts have been found completely resolves. After initial treatment, the patient is then in patients on very high doses of TAC-A on an experimental seen in two to three weeks. Clearing is expected and will last basis but do not occur in patients on the suggested doses of an almost predictable 18-21 days. Early signs of recurrence 40mg or less per month.2 prompt another dose administration of 40mg. The patient is Other infrequent events seen with suggested doses of then seen in about a month. Remission lasts longer with each TAC-A include hirsutism, acneiform eruptions, emotional successive dose, and the intervals are gradually extended to six lability (mood swings, insomnia, hyperirritability), and post- weeks then to three months. Of note, this treatment is only menopausal spotting. Increased blood sugar in diabetics is a effective if patients follow the advice of their dermatologist: potential problem that must be monitored. Suggested doses minimize hand-washing and moisturize each time their hands of TAC-A as outlined above have not been reported to have are wet, use mild soaps, cotton liners and rubber gloves with an effect on intraocular pressure, hypertension, avascular dish-washing, and avoid any specific irritants or allergents necrosis of the femoral head, gastric upset, purple striae, or fat that would potentiate the hand eczema. redistribution (moon facies, buffalo hump, etc.). All of these Note that if divided to represent the average daily dose of problems have been observed, for example, with oral pred- oral triamcinolone, these relatively small doses of TAC-A nisone over long periods. This fact again demonstrates the would be well under 2mg, lessening the risks of undesirable uniqueness and safety of TAC-A in recommended doses. December 2008 Practical Dermatology 51 BMD Testing Table 1. Conditions for Which IM TAC-A Demonstrates Benefit ication for a number of der- matologic disorders. Used judiciously, it is safe, and seri- Atopic Eczema Aquagenic Pruritus ous side effects are rare and Lichen Simplex Chronicus Lichen Sclerosus predictable; however, little is Prurigo Nodularis Balanitis known about the drug’s effect Neurotic Excoriations Erythema Annulare Centrifugum on bone mineral density (BMD). Factitial Dermatitis Stomatitis and Cheilitis Nummular Eczema Pemphigus Investigating Effects Chronic Hand Eczema Papular Urticaria including on BMD Bullous Keratolysis Exfoliativa Insect Bite Reactions Significant bone loss is a pre- dictable event in patients on Infectious Eczematoid Dermatitis Generalized Granuloma oral glucocorticoids and is Seborrheic Dermatitis Annulare most dramatic in the first Inflammatory Keratosis Pilaris Chronic Blepharitis three to six months of thera- 11,12 Bullous Pemphigoid Cholinergic Urticaria py. Baseline DXA scans and concurrent bisphospho- Chronic Urticaria including Dermographism Granuloma Faciale nate treatment are recom- Erythema Multiforme/Erythema Nodosum Essential Pruritus mended for patients in whom Aquagenic Urticaria Sunburn long-term oral glucocorticoid Photosensitivity including Seasonal Adult Mastocytosis therapy is anticipated. In order to assess the Lupus Erythematosus Pityriasis Rosea effects of TAC-A on BMD, Knuckle pads including Fingertip Lichen Amyloidosis data were collected from the Hyperkeratosis Onycholysis medical records of 32 patients Intertrigo Polymorphous Light Eruption (18 women and 14 men), who were on long-term TAC- Pityriasis Alba & Post-Inflammatory Pityriasis Rubra Pilaris A for various dermatologic Hypopigmentation Stasis Dermatitis conditions (Table 2). The Pseudoacanthosis Nigricans Lichen Planus average length of treatment Brachioradial Pruritus was 8.6 years per patient. The average daily dose of TAC-A was calculated at 0.5mg (total milligrams of TAC-A divided Applications of TAC-A by the number of days of treatment). Bone mineral density Table 1 provides a listing of conditions for which TAC-A was ascertained employing dual energy X-ray absorptiometry treatment has been found effective.3 A special note should be (DXA). made regarding aquagenic pruritus. Complete control of this The average age of the 18 women at the time of DXA very annoying problem with periodic TAC-A (40mg every scans was over 65 years (range 53-81). Six had BMD T- two to three months) has been obtained in 15 patients. No scores in the osteoporosis range, and 10 were osteopenic. other corticosteroid has this profound effect, and antihista- One patient (subject #30) had a minor osteoporotic fracture mines are of no value.4 of the wrist. About half of postmenopausal women in the Despite the utility of TAC-A, adjunctive treatment with general population have a bone density T-score at the other medications is commonly necessary. Examples include femoral neck between –1.0 and –2.55 (osteopenia). In the chloroquine with lupus erythematosus, antibiotics with present study, 55 percent of the women were osteopenic. inflammatory rosacea, acyclovir with herpes zoster, azathio- Osteoporosis would be expected in 35 percent of women in prine with pemphigus, antihistamines with chronic urticaria, the general population over 65,6 about the same as that and acitretin with pityriasis rubra pilaris. found in this study group (33 percent). In short, intramuscular triamcinolone is a valuable med- The average age of the 14 men at the time of DXA scans 52 Practical Dermatology December 2008 Table 2. Bone Mineral Density / Treatment Data Subject Age Date of Treatment Lumbar Spine Femur Bisphosphonates 1 No. (Sex) DXA Scan Total Period TAC-A2 (mg) T-Score3 BMD4_ T-Score3 BMD4_ Pre-Scan Post-Scan 1 47 (F) 1/25/99 5yrs.8mos. 1520 0.435 0.3725 0.136 0.8266 _ _ 2 68 (F) 1/30/99 3yrs.6mos. 520 -0.645 0.3185 -2.366 0.6696 _ _ 74 (F) 6/15/05 6yrs.4mos. 680 -1.585 0.2715 -4.076 0.5626 _ + 3 66 (F) 8/29/00 11yrs.11mos. 1120 -3.4 0.361 _ + 70 (F) 11/16/04 4yrs.1mo. 1000 -1.0 0.942 -1.1 0.809 + + 4 81 (F) 11/18/04 17yrs. 1200 -3.37 0.77 -2.41 0.63 _ + 5 76 (F) 3/2/05 3yrs.7mos. 360 -1.7 0.492 -2.1 0.747 _ + 6 62 (F) 4/18/05 11yrs. 1480 -3.55 0.774 -1.54 0.795 _ + 7 78 (M) 4/19/05 4yrs.2mos. 720 1.1 1.209 -0.3 0.982 _ _ 8 77 (F) 3/7/06 5yrs. 880 0.8 1.275 -1.9 0.789 _ + 9 73 (M) 4/12/06 7yrs.2mos. 1920 -3.2 0.85 -1.6 0.885 _ + 10 60 (F) 4/13/06 1yr.3mos. 320 -0.6 1.129 -1.2 0.859 _ _ 11 57 (M) 5/14/06 16yrs.1mo. 2960 0.1 1.24 -1.3 0.90 _ + 12 58 (M) 6/13/06 12yrs.3mos. 4400 -0.8 1.149 -1.3 0.917 _ _ 13 61 (F) 3/21/04 13yrs.1mo. 1360 -2.1 0.947 0.1 1.010 _ + 63 (F) 6/23/06 2yrs.2mos. 160 -2.2 0.932 -0.5 0.945 + + 14 66 (F) 8/30/04 0 0 1.0 1.322 0.1 1.009 _ _ 67 (F) 6/26/06 1yr.10mos. 400 0.7 1.288 -0.7 0.918 _ _ 15 70 (M) 8/16/99 0 0 1.8 1.438 0.2 1.117 _ _ 77 (M) 7/5/06 1yr.7mos.
Load more

Recommended publications
  • Aquagenic Pruritus: First Manifestation of *Corresponding Author Polycythemia Vera Jacek C
    DERMATOLOGY ISSN 2473-4799 http://dx.doi.org/10.17140/DRMTOJ-1-102 Open Journal Mini Review Aquagenic Pruritus: First Manifestation of *Corresponding author Polycythemia Vera Jacek C. Szepietowski, MD, PhD Department of Dermatology Venereology and Allergology Wroclaw Medical University Edyta Lelonek, MD; Jacek C. Szepietowski, MD, PhD* Ul. Chalubinskiego 1 50-368 Wroclaw, Poland E-mail: [email protected] Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland Volume 1 : Issue 1 Article Ref. #: 1000DRMTOJ1102 ABSTRACT Article History Aquagenic Pruritus (AP) can be a first symptom of systemic disease; especially strong th Received: January 25 , 2016 correlation with myeloproliferative disorders was described. In Polycythemia Vera (PV) pa- th Accepted: February 18 , 2016 tients its prevalence varies from 31% to 69%. In almost half of the cases AP precedes the th Published: February 19 , 2016 diagnosis of PV and has significant influence on sufferers’ quality of life. Due to the lack of the insight in pathogenesis of AP the treatment is still largely experiential. However, the new Citation JAK1/2 inhibitors showed promising results in management of AP among PV patients. Lelonek E, Szepietowski JC. Aqua- genic pruritus: first manifestation of polycythemia vera. Dermatol Open J. KEYWORDS: Aquagenic pruritus; Polycythemia vera; JAK inhibitors. 2016; 1(1): 3-5. doi: 10.17140/DRM- TOJ-1-102 Aquagenic pruritus (AP) is a skin condition characterized by the development of in- tense itching without observable skin lesions and evoked by contact with water at any tempera- ture. Its prevalence varies from 31% to 69% in Polycythemia vera (PV) patients.1,2,3 It has sig- nificant influence on sufferers’ quality of life and can exert a psychological effect to the extent of abandoning bathing or developing phobia to bathing.
    [Show full text]
  • The Itch New Yorker 2008
    The New Yorker June 30, 2008 Annals of Medicine The Itch Its mysterious power may be a clue to a new theory about brains and bodies. by Atul Gawande It was still shocking to M. how much a few wrong turns could change your life. She had graduated from Boston College with a degree in psychology, married at twenty-five, and had two children, a son and a daughter. She and her family settled in a town on Massachusetts’ southern shore. She worked for thirteen years in health care, becoming the director of a residence program for men who’d suffered severe head injuries. But she and her husband began fighting. There were betrayals. By the time she was thirty-two, her marriage had disintegrated. In the divorce, she lost possession of their home, and, amid her financial and psychological struggles, she saw that she was losing her children, too. Within a few years, she was drinking. She began dating someone, and they drank together. After a while, he brought some drugs home, and she tried them. The drugs got harder. Eventually, they were doing heroin, which turned out to be readily available from a street dealer a block away from her apartment. One day, she went to see a doctor because she wasn’t feeling well, and learned that she had contracted H.I.V. from a contaminated needle. She had to leave her job. She lost visiting rights with her children. And she developed complications from the H.I.V., including shingles, which caused painful, blistering sores across her scalp and forehead.
    [Show full text]
  • Psychiatric Comorbidities in Non-Psychogenic Chronic Itch, a US
    1/4 CLINICAL REPORT Psychiatric Comorbidities in Non-psychogenic Chronic Itch, a US- DV based Study 1 1 1 1 1 2 cta Rachel Shireen GOLPANIAN , Zoe LIPMAN , Kayla FOURZALI , Emilie FOWLER , Leigh NATTKEMPER , Yiong Huak CHAN and Gil YOSIPOVITCH1 1 2 A Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, Miami, USA, and Clinical Trials and Epidemiology Research Unit, Singapore Research suggests that itch and psychiatric diseases SIGNIFICANCE are intimately related. In efforts to examine the preva- lence of psychiatric diagnoses in patients with chronic The primary aim of this study was to examine the preva- itch not due to psychogenic causes, we conducted a lence of psychiatric diagnoses in patients with chronic itch retrospective chart review of 502 adult patients diag- that is not due to psychogenic causes. The secondary aim nosed with chronic itch in an outpatient dermatology of this study was to determine whether psychiatric diagno- clinic specializing in itch and assessed these patients ses have any correlation to specific itch characteristics such enereologica for a co-existing psychiatric disease. Psychiatric di- as itch intensity, or if there are any psychiatric-specific di- V sease was identified and recorded based on ICD-10 seases this patient population is more prone to. This infor- codes made at any point in time which were recor- mation will not only allow us to better understand the po- ded in the patient’s electronic medical chart, which tential factors underlying the presentation of chronic itch, includes all medical department visits at the Univer- but also allow us to provide these patients with more holis- ermato- sity of Miami.
    [Show full text]
  • European Guideline Chronic Pruritus Final Version
    EDF-Guidelines for Chronic Pruritus In cooperation with the European Academy of Dermatology and Venereology (EADV) and the Union Européenne des Médecins Spécialistes (UEMS) E Weisshaar1, JC Szepietowski2, U Darsow3, L Misery4, J Wallengren5, T Mettang6, U Gieler7, T Lotti8, J Lambert9, P Maisel10, M Streit11, M Greaves12, A Carmichael13, E Tschachler14, J Ring3, S Ständer15 University Hospital Heidelberg, Clinical Social Medicine, Environmental and Occupational Dermatology, Germany1, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland2, Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany3, Department of Dermatology, University Hospital Brest, France4, Department of Dermatology, Lund University, Sweden5, German Clinic for Diagnostics, Nephrology, Wiesbaden, Germany6, Department of Psychosomatic Dermatology, Clinic for Psychosomatic Medicine, University of Giessen, Germany7, Department of Dermatology, University of Florence, Italy8, Department of Dermatology, University of Antwerpen, Belgium9, Department of General Medicine, University Hospital Muenster, Germany10, Department of Dermatology, Kantonsspital Aarau, Switzerland11, Department of Dermatology, St. Thomas Hospital Lambeth, London, UK12, Department of Dermatology, James Cook University Hospital Middlesbrough, UK13, Department of Dermatology, Medical University Vienna, Austria14, Department of Dermatology, Competence Center for Pruritus, University Hospital Muenster, Germany15 Corresponding author: Elke Weisshaar
    [Show full text]
  • Urticaria from Wikipedia, the Free Encyclopedia Jump To: Navigation, Search "Hives" Redirects Here
    Urticaria From Wikipedia, the free encyclopedia Jump to: navigation, search "Hives" redirects here. For other uses, see Hive. Urticaria Classification and external resourcesICD-10L50.ICD- 9708DiseasesDB13606MedlinePlus000845eMedicineemerg/628 MeSHD014581Urtic aria (or hives) is a skin condition, commonly caused by an allergic reaction, that is characterized by raised red skin wheals (welts). It is also known as nettle rash or uredo. Wheals from urticaria can appear anywhere on the body, including the face, lips, tongue, throat, and ears. The wheals may vary in size from about 5 mm (0.2 inches) in diameter to the size of a dinner plate; they typically itch severely, sting, or burn, and often have a pale border. Urticaria is generally caused by direct contact with an allergenic substance, or an immune response to food or some other allergen, but can also appear for other reasons, notably emotional stress. The rash can be triggered by quite innocent events, such as mere rubbing or exposure to cold. Contents [hide] * 1 Pathophysiology * 2 Differential diagnosis * 3 Types * 4 Related conditions * 5 Treatment and management o 5.1 Histamine antagonists o 5.2 Other o 5.3 Dietary * 6 See also * 7 References * 8 External links [edit] Pathophysiology Allergic urticaria on the shin induced by an antibiotic The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, and resulting in an edema which persists until the interstitial fluid is absorbed into the surrounding cells. Urticarial disease is thought to be caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin.
    [Show full text]
  • Pruritus: Scratching the Surface
    Pruritus: Scratching the surface Iris Ale, MD Director Allergy Unit, University Hospital Professor of Dermatology Republic University, Uruguay Member of the ICDRG ITCH • defined as an “unpleasant sensation of the skin leading to the desire to scratch” -- Samuel Hafenreffer (1660) • The definition offered by the German physician Samuel Hafenreffer in 1660 has yet to be improved upon. • However, it turns out that itch is, indeed, inseparable from the desire to scratch. Savin JA. How should we define itching? J Am Acad Dermatol. 1998;39(2 Pt 1):268-9. Pruritus • “Scratching is one of nature’s sweetest gratifications, and the one nearest to hand….” -- Michel de Montaigne (1553) “…..But repentance follows too annoyingly close at its heels.” The Essays of Montaigne Itch has been ranked, by scientific and artistic observers alike, among the most distressing physical sensations one can experience: In Dante’s Inferno, falsifiers were punished by “the burning rage / of fierce itching that nothing could relieve” Pruritus and body defence • Pruritus fulfils an essential part of the innate defence mechanism of the body. • Next to pain, itch may serve as an alarm system to remove possibly damaging or harming substances from the skin. • Itch, and the accompanying scratch reflex, evolved in order to protect us from such dangers as malaria, yellow fever, and dengue, transmitted by mosquitoes, typhus-bearing lice, plague-bearing fleas • However, chronic itch lost this function. Chronic Pruritus • Chronic pruritus is a common and distressing symptom, that is associated with a variety of skin conditions and systemic diseases • It usually has a dramatic impact on the quality of life of the affected individuals Chronic Pruritus • Despite being the major symptom associated with skin disease, our understanding of the pathogenesis of most types of itch is limited, and current therapies are often inadequate.
    [Show full text]
  • Update of the Guideline on Chronic Pruritus
    Update of the Guideline on Chronic Pruritus Developed by the Guideline Subcommittee “Chronic Pruritus” of the European Dermatology Forum Subcommittee Members: Prof. Dr. Elke Weisshaar, Heidelberg (Germany) Prof. Dr. Sonja Ständer, Münster (Germany) Prof. Dr. Erwin Tschachler, Wien (Austria) Prof. Dr. Torello Lotti, Florence (Italy) Prof. Dr. Johannes Ring, Munich (Germany) Prof. Dr. Laurent Misery, Brest (France) Dr. Markus Streit, Aarau (Switzerland) Prof. Dr. Thomas Mettang, Wiesbaden (Germany) Prof. Dr. Jacek Szepietowski, Wroclaw (Poland) Prof. Dr. Joanna Wallengren, Lund (Sweden) Dr. Peter Maisel, Münster (Germany) Prof. Dr. Uwe Gieler, Gießen (Germany) Prof. Dr. Malcolm Greaves (Singapore) Prof. Dr. Ulf Darsow, Munich (Germany) Prof. Dr. Julien Lambert, Antwerp (Belgium) Members of EDF Guideline Committee: Prof. Dr. Werner Aberer, Graz (Austria) Prof. Dr. Dieter Metze, Münster (Germany) Prof. Dr. Martine Bagot, Paris (France) Dr. Kai Munte, Rotterdam (Netherlands) Prof. Dr. Nicole Basset-Seguin, Paris (France) Prof. Dr. Gilian Murphy, Dublin (Ireland) Prof. Dr. Ulrike Blume-Peytavi, Berlin (Germany) Prof. Dr. Martino Neumann, Rotterdam (Netherlands) Prof. Dr. Lasse Braathen, Bern (Switzerland) Prof. Dr. Tony Ormerod, Aberdeen (UK) Prof. Dr. Sergio Chimenti, Rome (Italy) Prof. Dr. Mauro Picardo, Rome (Italy) Prof. Dr. Alexander Enk, Heidelberg (Germany) Prof. Dr. Johannes Ring, Munich (Germany) Prof. Dr. Claudio Feliciani, Rome (Italy) Prof. Dr. Annamari Ranki, Helsinki (Finland) Prof. Dr. Claus Garbe, Tübingen (Germany) Prof. Dr. Berthold Rzany, Berlin (Germany) Prof. Dr. Harald Gollnick, Magdeburg (Germany) Prof. Dr. Rudolf Stadler, Minden (Germany) Prof. Dr. Gerd Gross, Rostock (Germany) Prof. Dr. Sonja Ständer, Münster (Germany) Prof. Dr. Vladimir Hegyi, Bratislava (Slovakia) Prof. Dr. Eggert Stockfleth, Berlin (Germany) Prof. Dr.
    [Show full text]
  • Etiology, Classification, and Treatment of Urticaria
    CONTINUING MEDICAL EDUCATION Etiology, Classification, and Treatment of Urticaria Kjetil Kristoffer Guldbakke, MD; Amor Khachemoune, MD, CWS GOAL To understand urticaria to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical classification of urticaria. 2. Recognize how to diagnose urticaria. 3. Identify treatment options. CME Test on page 50. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. December 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Guldbakke and Khachemoune report no conflict of interest. The authors discuss off-label use of colchi- cine, cyclophosphamide, cyclosporine, dapsone, intravenous immunoglobulin, methotrexate, montelukast sodium, nifedipine, plasmapheresis, rofecoxib, sulfasalazine, tacrolimus, thyroxine, and zafirlukast. Dr. Fisher reports no conflict of interest. Urticaria is among the most common skin dis- autoimmune mechanisms are now recognized as a eases. It can be acute, chronic, mediated by a cause of chronic urticaria. A search of the PubMed physical stimulus, or related to contact with an database (US National Library of Medicine) for urticant.
    [Show full text]
  • Local Heat Urticaria
    Volume 23 Number 12 | December 2017 Dermatology Online Journal || Case Presentation DOJ 23 (12): 10 Local heat urticaria Forrest White MD, Gabriela Cobos MD, and Nicholas A Soter MD Affiliations: 1 New York University Langone Health, New York Abstract PHYSICAL EXAMINATION: A brisk, mechanical stroke elicited a linear wheal. Five minutes after exposure We present a 38-year-old woman with local heat to hot water, she developed well-demarcated, urticaria confirmed by heat provocation testing. Heat erythematous blanching wheals that covered the urticaria is a rare form of physical urticaria that is distal forearm and entire hand. triggered by exposure to a heat source, such as hot water or sunlight. Although it is commonly localized Conclusion and immediate, generalized and delayed onset forms Physical or inducible urticarias are a group of exist. Treatment options include antihistamines urticarias that are triggered by various external and heat desensitization. A brisk, mechanical stroke physical stimuli, such as mechanical stimuli, pressure, elicited a linear wheal. Five minutes after exposure cold, light, or temperature change. Urticarias due to hot water, she developed well-demarcated, to temperature change include heat urticaria (HU), erythematous blanching wheals that covered the cholinergic urticaria, and cold urticaria. distal forearm and entire hand. HU is a rare form of chronic inducible urticaria, with Keywords: urticaria, local heat urticaria, physical approximately 60 reported cases [1]. In HU, contact urticaria with a heat source such as hot water, sunlight, hot air, radiant heat, or hot objects results in wheal formation Introduction HISTORY: A 38-year-old woman presented to the Skin and Cancer Unit for the evaluation of recurrent, intensely pruritic eruptions that were precipitated by exposure to heat, which included hot water and sunlight.
    [Show full text]
  • Urticaria and Angioedema
    Skin tests may be performed to determine the substance that you are allergic to. Routine blood tests are done to determine if a systemic illness is present. Urticaria and Treatment for Urticaria and Angioedema Angioedema • The best treatment for hives and angioedema is to identify and remove the trigger, but this is often a hard task. • Antihistamines block the effect of histamine, and can reduce itching and rash in most cases. Antihistamines may be needed for as long as the urticaria persists. Reports of serious side effects of antihistamines are very rare. Allergy Centre • A low histamine diet can help to reduce exogenous histamine derived from foods, which helps in some cases. To find out more about a low histamine diet, please contact our dietitian. 過敏病科中心 • Oral corticosteroids may be prescribed. • For a severe hives or angioedema outbreak, an injection of adrenaline or a steroid medication may be needed. • Other immunosuppressant such as cyclosporin may be beneficial in severe cases for long term control. For enquiries and appointments, Tips to Manage Urticaria and please contact us at: Angioedema Allergy Centre • Avoid hot water; use lukewarm water 9/F, Li Shu Pui Block • Use gentle, mild soap Hong Kong Sanatorium & Hospital 2 Village Road, Happy Valley, Hong Kong • Apply cool compresses or wet cloths to the affected areas Tel: 2835 8430 Fax: 2892 7565 • Try to work and sleep in a cool room Email: [email protected] • Wear loose-fitting lightweight clothes Service Hours • Avoid foods that are fermented or high in colorings Mon, Tue, Thu & Fri : 9:00 am – 6:00 pm ALC.038I.H/E-03-102017 and preservatives Wed & Sat : 9:00 am – 1:00 pm 過敏病科中心 • Keep a food dairy to identify any specific food triggers Closed on Sundays and Public Holidays www.hksh-hospital.com Allergy Centre A member of HKSH Medical Group © Hong Kong Sanatorium & Hospital Limited.
    [Show full text]
  • 10 Chronic Urticaria As an Autoimmune Disease
    10 Chronic Urticaria as an Autoimmune Disease Michihiro Hide, Malcolm W. Greaves Introduction Urticaria is conventionally classified as acute, intermittent and chronic (Grea- ves 2000a). Acute urticaria which frequently involves an IgE-mediated im- munological mechanism, is common, its causes often recognised by the patient, and will not be considered further. Intermittent urticaria – frequent bouts of unexplained urticaria at intervals of weeks or months – will be dis- cussed here on the same basis as ‘ordinary’ chronic urticaria. The latter is conventionally defined as the occurrence of daily or almost daily whealing for at least six weeks. The etiology of chronic urticaria is usually obscure. The different clinical varieties of chronic urticaria will be briefly considered here, and attention will be devoted to a newly emerged entity – autoimmune chronic urticaria, since establishing this diagnosis has conceptual, prognostic and the- rapeutic implications. Contact urticaria and angioedema without urticaria will not be dealt with in this account. Classification of Chronic Urticaria The clinical subtypes of chronic urticaria are illustrated in the pie-chart of Fig. 1. The frequency of these subtypes is based upon the authors’ experience at the St John’s Institute of Dermatology in UK. Whilst there may well be mi- nor differences, it is likely that the frequency distribution of these subtypes will be essentially similar in most centres in Europe and North America (Grea- ves 1995, 2000b). However, our experience suggests that the incidence of angioedema, especially that complicated by ordinary chronic urticaria is sub- stantially lower in Japan and south Asian countries (unpublished observation). 310 Michihiro Hide and Malcolm W.
    [Show full text]
  • Urticaria and Angioedema
    Urticaria and Angioedema This guideline, developed by Robbie Pesek, MD and Allison Burbank, MD, in collaboration with the ANGELS team, on July 23, 2013, is a significantly revised version of the guideline originally developed by Jeremy Bufford, MD. Last reviewed by Robbie Pesek, MD September 14, 2016. Key Points Urticaria and angioedema are common problems and can be caused by both allergic and non- allergic mechanisms. Prompt diagnosis of hereditary angioedema (HAE) is important to prevent morbidity and mortality. Several new therapeutic options are now available. Patients with urticaria and/or angioedema should be referred to an allergist/immunologist for symptoms that are difficult to control, suspicion of HAE, or to rule out suspected allergic triggers. Definition, Assessment, and Diagnosis Definitions Urticaria is a superficial skin reaction consisting of erythematous, raised, blanching, well- circumscribed or confluent pruritic, edematous wheals, often with reflex erythema.1-3 Urticarial lesions are typically pruritic, and wax/wane with resolution of individual lesions within 24 hours. Angioedema is localized swelling of deep dermal, subcutaneous, or submucosal tissue resulting from similar vascular changes that contribute to urticaria.1,2 Angioedema may be pruritic and/or painful and can last for 2-3 days depending on etiology.3 1 Urticaria alone occurs in 50% of patients and is associated with angioedema in 40% of patients. Isolated angioedema occurs in 10% of patients.1,2 Hereditary angioedema (HAE) is a disorder involving defects in complement, coagulation, kinin, and fibrinolytic pathways that results in recurrent episodes of angioedema without urticaria, usually affecting the skin, upper airway, and gastrointestinal tract.4 In children, acute urticaria is more common than chronic forms.
    [Show full text]