General Medical Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Common causes: Viral: herpes zosterherpes simplex.Impetigo.Scabies.Insect bites and papular urticaria.Bullous eczema and pompholyx.Drugs – sulphonamides, penicillin, barbiturates.Contact dermatitis.
Bites
Gail Miriam Moraru, Jerome Goddard in The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Fleas. Flea bites often occur in irregular groups of several to a dozen or more. The typical flea bite on a human consists of a central spot surrounded by an erythematous ring. There is usually little swelling, but the center may be elevated into a papule, vesicle, or bulla. Papular urticaria is seen in persons with chronic exposure to flea bites. The lesions appear in crops, and all stages can be seen simultaneously—fresh wheals, persistent papules, vesicles, scratch marks, exudation, encrustation, and often secondary infection.
Bites and stings
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
The type and distribution of skin lesions are different for different arthropods. The most often observed lesion is papular urticaria. Bullous lesions are common on the legs, but may occur in other sites, especially in children. Hemorrhagic or ulcerated lesions have been reported, especially in the presence of lower limb venous hypertension. Cellulitis and lymphangitis may develop. Pseudoangiomatosis-like lesions have been reported [2].
Current and emerging pharmacotherapy for chronic spontaneous Urticaria: a focus on non-biological therapeutics
Published in Expert Opinion on Pharmacotherapy, 2021
Kam Lun Hon, Joyce T. S. Li, Alexander K.C. Leung, Vivian W. Y. Lee
The hallmark of urticaria is that the hives or wheals rapidly wax and wane, and the process rarely persist beyond 24 hours. Urticaria or hives are characterized by pruritic wheals of the superficial layers of the skin [1–4]. According to the joint initiative of the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA2LEN), European Academy of Allergology and Clinical Immunology (EAACI), the World Allergy Organization (WAO), and the European Dermatology Forum (EDF), isolated idiopathic angioedema, even without urticaria, is included in the definition of urticaria, if other disorders of angioedema (especially bradykinin-mediated) have been ruled out [5]. Urticaria is classified as chronic or acute. Chronic urticaria (CU) refers to urticaria (wheals), angioedema, or both which occurs for a period of ≥ six weeks, on most days of the week [5,6]. CU is further subtyped as chronic spontaneous urticaria (CSU), previously named chronic idiopathic urticaria, and chronic inducible urticaria that occurs in response to specific and reproducible triggers such as pressure, cold, heat, exercise, emotions, and vibration [7].
Does synthetic pharmacotherapy still have a place in treating chronic spontaneous urticaria?
Published in Expert Opinion on Pharmacotherapy, 2022
Rebecca M. Thiede, Mohammad Fazel, Karen M. MacDonald, Ivo Abraham
Chronic urticaria is an inflammatory disease driven by mast cells and characterized by spontaneous wheals (with individual lesions self-resolving in <24 hours) and/or angioedema for at least 6 weeks occurring in relation to known or unknown causes. Also known as hives, urticaria can be inducible or spontaneous. Inducible urticaria is characterized by the development of wheals, angioedema, or both in response to a specific external physical trigger and will not occur without this trigger: cold, heat, sunlight, pressure, exercise, contact with offending solid or liquid substances, including foods, plant and animal matters, water, chemicals, among others. In contrast, symptoms of spontaneous urticaria (also referred to as idiopathic urticaria) occur without known or identifiable external physical triggers [1]. Resolution of chronic urticaria, inducible or spontaneous, may take several months or years. Treatment is necessary to limit flares, reduce pruritus, and improve quality of life. Chronic urticaria affects both the objective functioning and subjective well-being of patients [2–4]. The 2014 approval of the monoclonal antibody omalizumab as an add-on therapy, as well as biological therapies currently being evaluated, raises the question of the role, if any, of synthetic agents.
Pediatric chronic spontaneous urticaria: a brief clinician’s guide
Published in Expert Review of Clinical Immunology, 2022
Martina Votto, Giovanna Achilli, Maria De Filippo, Amelia Licari, Alessia Marseglia, Alice Moiraghi, Antonio Di Sabatino, Gian Luigi Marseglia
Urticaria is defined as a condition characterized by the development of wheals (hives) with or without angioedema. Hives are transient and usually last less than 24 hours. Itch is the most common associated symptom of urticaria. Urticarial lesions typically show the following features: 1) wheals appear as edematous, erythematous papules or plaques with a pale center and surrounding erythema; 2) they can be localized or generalized; 3) they have variable size and shape (round, oval, annular, arcuate, serpiginous) and resolve without skin changes. Angioedema is characterized by a sudden, pronounced edema of the lower dermis and subcutis or mucous membranes associated with tingling, burning, tightness, sometimes pain, and a slower resolution (up to 72 hours) [1]. Although the underlying mechanisms can be very distinct, the pathophysiology of urticaria and angioedema are similar and result in increased vascular permeability.
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