ABSTRACT
Objetivo: Revisar a literatura sobre urticária física (UF) incluindo a nova classificação, diagnóstico e opções terapêuticas. Fontes de dados: artigos originais, revisões e consensos indexados nos bancos de dados MEDLINE e LILACS de 2002 a 2007 e livros. Palavras de busca: urticária física, urticária ao frio, dermografismo, urticária ao calor, angioedema vibratório, urticária solar, urticária de pressão, urticária colinérgica, urticária aquagênica e anafilaxia induzida por exercício. Resultados: Nas últimas décadas um aumento na compreensão dos mecanismos envolvidos na urticária tem realçado a heterogeneidade de seus diferentes subtipos. De acôrdo com o novo guia da Academia Européia de Alergologia e Imunologia Clínica os subtipos de urticária podem ser agrupados em: urticárias espontâneas, urticárias físicas e outras urticárias. As urticárias físicas (UF) são responsáveis por cerca de 20 per cent a 30 per cent de todos os casos de urticária crônica. A UF envolve patogênese, curso clínico e terapêutico complexos. A parte mais importante da avaliação diagnóstica consiste na obtenção de extensa e detalhada história clínica e exame físico. Testes de provocação são empregados para confirmar o diagnóstico. A UF quando se manifesta isoladamente, tende a responder bem a anti-histamínicos H1, a exceção da urticária de pressão tardia. Comentários: As UFs constituem um subgrupo singular de urticária em que os pacientes desenvolvem lesões secundárias a estímulos físicos. Desencadeantes comuns incluem: exercício, frio, calor, pressão, luz solar e vibração. Sintomas sistêmicos podem ocorrer durante episódios graves. As UFs têm um profundo impacto sobre qualidade de vida e performance, assim, um conhecimento básico dessas doenças raras é importante para todos os que cuidam da saúde.
Objective: To review the literature on physical urticaria including the new classification, diagnosis and therapeutic options. Sources of data: books, original articles, reviews and consensus indexed on MEDLINE and LILACS databases from 2002 to 2007. Kew words researched: physical urticaria, cold urticaria, dermatographism, heat urticaria vibratory angioedema, solar urticaria, pressure urticaria, cholinergic urticaria, aquagenic urticaria and exercise-induced anaphylaxis Results: In the last few decades an increasing understanding of the mechanisms involved in urticaria has highlighted the heterogeneity of its different subtypes. According to the new European Academy of Allergology and Clinical Immunology guidelines, urticaria subtypes can be grouped into spontaneous urticaria, physical urticaria, and other urticaria disorders. Physical urticarias (PU) are responsible for approximately 20 per cent to 30 per cent of all cases of chronic urticaria. PU involves complex pathogenesis, clinical course and therapy. The most important part of the diagnostic evaluation is a comprehensive and detailed history and physical examination. Physical challenge tests are used to confirm the diagnosis. PU, when manifesting isolated, tends to respond well to H 1 antihistamines, with the exception of delayed pressure urticaria. Comments: PU are a unique subgroup of chronic urticaria in which patients develop lesions secondary to physical stimuli. Common triggers include: exercise, cold, heat, pressure, sunlight, and vibration. Systemic symptoms have occurred during severe episodes. PU has a profound impact on quality of Iife and performance. 50, a basic knowledge of these unusual disorders is important for all healthcare providers. .
Subject(s)
Humans , Anaphylaxis , Angioedema , Hypersensitivity, Immediate , Urticaria , Methods , Skin Tests , Diagnostic Techniques and ProceduresABSTRACT
Solar urticaria is an uncommon photodermatosis characterized by the occurrence of pruritic erythema and wheals after exposure to sunlight or artificial radiation. A 52-year-old woman presented with a month long history of pain, wheal and sometimes mild dyspnea which developed after sunlight exposure. Phototesting for UVA, UVB and visible light were all positive, which has never been reported in Korea. The patient was treated with antihistamine and antimalarial drug.
Subject(s)
Female , Humans , Middle Aged , Dyspnea , Erythema , Korea , Light , Sunlight , UrticariaABSTRACT
BACKGROUND: Solar urticaria is an uncommon photodermatosis characterized by the appearance of wheals after sun exposure. Although many sporadic cases have been reported, little is known about the clinical characteristics in Korean patients. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of solar urticaria in Korean patients, with an emphasis on demographic characteristics and action spectrum. METHODS: A retrospective analysis was conducted of the records of patients phototested at Seoul National University and subsequently diagnosed with solar urticaria. RESULTS: A total 11 solar urticaria patients were used in this study. The mean age was 24 years. Nine (82%) patients were male and two patients (18%) were female. The mean age of onset was 20.8 years. The mean exposure time to wheal formation was 24 minutes and mean duration of wheal was 98 minutes. The action spectra of solar urticaria were visible light for 6 (55%) patients, ultraviolet A (UVA) for 2 (18%), both visible light and UVA for one (9%), both visible light and UVB for one, and natural sunlight for one. CONCLUSION: Visible light was the most common action spectrum in this study. Our findings illustrate the clinical and photobiological characteristics of solar urticaria in Korean patients.
Subject(s)
Female , Humans , Male , Age of Onset , Light , Retrospective Studies , Seoul , Solar System , Sunlight , UrticariaABSTRACT
Solar urticaria can be defined as an idiopathic photodermatosis characterized by the occurrence of itchy erythematous or urticarial lesions that are provoked only by sunlight and disappear nearly within 24 hours after avoidance of sun exposure. A 25-year-old male patient was presented with a 7-year history of recurrent wheals and itching, which developed after sunlight exposure. Cutaneous lesions and itching completely subside within 2 hours after avoidance of sunlight. Phototesting for UVB, UVA and visible light were all negative. But provocative test with natural sunlight showed positive result. Histopathologically, edema of papillary dermis and mild perivascular inflammatory infiltrations were seen.
Subject(s)
Adult , Humans , Male , Dermis , Edema , Light , Pruritus , Solar System , Sunlight , UrticariaABSTRACT
Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing occurring minutes after exposure to sunlight or artificial radiation, and generally resolves in a few hours. A 46-year-old woman presented with a 2-year history of pruritus and whealing, which occurred immediately after exposure to sunlight. Phototesting elicited urticarial reactions in the UVA and visible sepectra. The results of passive and reverse passive transfer studies were all negative. The patient was treated with cetirizine, doxepin and prednisolone. After 2 months of the treatment, the symptoms did not appear.
Subject(s)
Female , Humans , Middle Aged , Cetirizine , Doxepin , Erythema , Prednisolone , Pruritus , Sunlight , UrticariaABSTRACT
Solar urticaria is a rare disorder in which immediate erythema and wheals are induced by ultraviolet or visible irradiation. This condition usually occurs in the third and fifth decades of life and is very rare in childhood. A 3-year-old girl presented with a history of an erythematous rash which had occurred on the face and neck, immediately after exposure to sunlight for one month. A diagnosis of solar urtiacria was made on the clinical reviews and phototest. Other photosensitive disorders could be excluded by the clinical and laboratory findings. She was treated with ketotifen and sun protection showing good early results.
Subject(s)
Child , Child, Preschool , Female , Humans , Diagnosis , Erythema , Exanthema , Ketotifen , Neck , Solar System , Sunlight , UrticariaABSTRACT
A 23-year-old woman had solar urticaria that was activated by visible light and UVA, but the intensity of the urticarial reaction of visible light was more pronounced than that of UVA. The results of passive and reverse passive transfer studies were negative, We report a case of solar urticaria which is characterized by overlapping features of 60th type Il and Il[ in the classification of Harber.
Subject(s)
Female , Humans , Young Adult , Classification , Light , UrticariaABSTRACT
We report a case of solar urticaria being activated by both UVA and visible radiation and positive in passive transfer test by visible light, which was treated with sunlight and UVA radiation. A short course of treatment with sunlight produced no benificial effect. UVA phototherpy produced a rnarked increase in the minirnal urtication dose by UVA but there was no increased tolerance to sun exposure.
Subject(s)
Intradermal Tests , Light , Phototherapy , Solar System , Sunlight , UrticariaABSTRACT
Solar urticaria is an uncommon disorder characterized by rapid development of urticarial reaction in areas of skin exposed to nonizing electromagnetic radiation. Herber and Baer classified solar urticaria into eight types on the basis of action spectrum and passive or reverse passive transfer ability. We report two cases of type ]g solar urticaria which were activated by visible light and negative in both passive and reverse passive transfer test.