Urticaria

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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197 Urticaria

Instruction

Look at the skin of this patient, who has recurrent lesions.

Salient features

History

• Determine physical causes that could have precipitated this response: cold urticaria, dermatographism (Fig. 197.1), pressure, sunlight, exercise, hot shower

• Drug history: aspirin, NSAIDs, morphine, codeine, penicillin, sulphonamides

• Whether any foods precipitate the rash such as strawberries, seafood, nuts, chocolate

• Blood products causing these lesions.

• Wasp or bee stings

• Viral infections and febrile illnesses

• Know whether the patient has recurrent angioedema

• Obtain a history of atopy.

image

Fig. 197.1 Urticaria.

Examination

• Wheals that are smooth, oedematous, pin or red, and surrounded by a bright red flare. Clearing of the central area may leave an annular pattern.

• Associated scratch marks, indicating the wheals are itchy.

Proceed as follows:

• Tell the examiner that you would like to exclude infections (hepatitis, chronic sinusitis) and connective tissue disorders.

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