Urticarial Dermatitis: Clinical Characteristics of Itch and Therapeutic Response to Cyclosporine

BACKGROUND: Urticarial dermatitis, which is characterised by persistent wheals with eczematous papules and plaques, is frequently misdiagnosed and difficult to treat. Patients commonly experience intolerable pruritus which may greatly affect their quality of life. OBJECTIVE: The objective of this study is to characterize the clinical patterns of pruritus in patients with urticarial dermatitis and to determine the effectiveness of cyclosporine treatment. METHODS: This prospective study included 50 histopathologically confirmed patients with urticarial dermatitis. A face-to-face structured questionnaire was given to all patients, and they were treated with low-dose cyclosporine (1~3 mg/kg/d) for at least 2 weeks. RESULTS: The majority of patients (80.0%) had moderate to severe pruritus. Most patients experienced exacerbation of the itch in the evening (74.0%), with the extremities (upper, 86.0%; lower, 94.0%) being the most commonly involved sites. Due to severe pruritus, patients complained about reduced social contact, quality of life and difficulties in falling asleep et al. Cyclosporine significantly reduced the mean itch score and extent of erythema, and improved interference with daily activities and sleep. CONCLUSION: Our study highlights the detailed description and characteristics of pruritus in patients with urticarial dermatitis. And we recommend alternative and effective therapeutic option of low-dose cyclosporine.

A Clinical Study of Urticarial Dermatitis / 대한피부과학회지

BACKGROUND: Urticarial dermatitis is not a commonly used term but may be a useful term representing clinical and histological features as a subset of the dermal hypersensitivity reaction pattern. However, there have been no previous clinical studies on urticarial dermatitis in Korea. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics, courses, and responses to various treatments in patients with urticarial dermatitis. METHODS: From January 2007 to February 2009, a total of 24 Korean patients who were diagnosed with urticarial dermatitis by clinical and histological criteria were involved in this study. Retrospective analysis using their medical records and the routine blood tests including IgE was performed. RESULTS: Men (n=19) were involved more predominantly than women (n=5). The mean age of the patients was 49.4 years and the mean duration of the disease was 21.1 months. The skin lesion involved the trunk most commonly and spread throughout the entire body, particulary to the proximal part of the extremities. An abnormally elevated IgE level (mean 819.7 mg/dl) and eosinophil count (mean 7.3%) were observed in 12 patients and 9 patients, respectively. Combination therapy of an oral antihistamine agent and topical steroids was mostly not effective. The skin lesions and symptoms were improved transiently by low-dose corticosteroid therapy, dapsone, and narrow-band UVB (NBUVB) phototherapy, but relapsed or aggravated shortly after cessation of treatment or reduction of drug dosage. CONCLUSION: Urticarial dermatitis is mostly chronic with a waxing and waning disease course. The administration of dapsone or NBUVB phototherapy are additional therapeutic options to oral corticosteroids in the treatment of urticarial dermatitis.