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    This document discusses urticarial and indurated eruptions, which present as wheals or indurated papules/plaques without scale that can be caused internally or externally. It provides important history questions to ask patients with urticarial eruptions, such as how long lesions last and what medications they take, as well as important physical findings like distribution and presence of fever. Critical questions include whether patients have difficulty breathing or mucosal involvement, as these can indicate angioedema or anaphylaxis rather than simple urticaria.

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    This document discusses urticarial and indurated eruptions, which present as wheals or indurated papules/plaques without scale that can be caused internally or externally. It provides important history questions to ask patients with urticarial eruptions, such as how long lesions last and what medications they take, as well as important physical findings like distribution and presence of fever. Critical questions include whether patients have difficulty breathing or mucosal involvement, as these can indicate angioedema or anaphylaxis rather than simple urticaria.

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    16 views1 page

    First Page PDF

    Uploaded by

    fatimiahmasta
    This document discusses urticarial and indurated eruptions, which present as wheals or indurated papules/plaques without scale that can be caused internally or externally. It provides important history questions to ask patients with urticarial eruptions, such as how long lesions last and what medications they take, as well as important physical findings like distribution and presence of fever. Critical questions include whether patients have difficulty breathing or mucosal involvement, as these can indicate angioedema or anaphylaxis rather than simple urticaria.

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    of 1

    Chapter 5 

    Urticarial and Indurated Eruptions

    U rticarial eruptions yield, as a primary lesion, a


    wheal (hivelike) or something that resembles a
    wheal, creating a fixed indurated papule or plaque,
    urticaria, which is without mucosal or sinopulmonary
    involvement.

    without scale. This pattern may be produced by inter-


    nal and external causes. Most lesions are erythematous IMPORTANT PHYSICAL FINDINGS FOR
    (red). URTICARIAL ERUPTIONS
    Are any of the lesions annular?
    IMPORTANT HISTORY QUESTIONS FOR Some urticarial eruptions may be annular, or vaguely
    annular, and this is an important pattern to observe.
    URTICARIAL ERUPTIONS Simple urticaria (hives) may present with annular and
    How long have you had these lesions? nonannular lesions.
    Attempt to establish the duration of illness. Some urti-
    carial processes are acute (e.g., acute urticaria, Sweet Are any of the lesions linear?
    syndrome), whereas others are present for weeks, Linear lesions suggest dermatographism, which can
    months, or even years (e.g., chronic urticaria). be tested by stroking the skin with a firm object and
    waiting 3 to 6 minutes to identify an erythematous
    How long do individual lesions last? line. The line should disappear in 15 to 30 minutes.
    In simple urticaria (hives), the individual lesions lasts
    less than 24 hours, although the rash may last longer. Do any of the lesions demonstrate
    This differs from urticarial vasculitis, in which indi- focal hemorrhage?
    vidual lesions last longer than 24 hours. As a sep- Simple urticaria does not demonstrate associated
    arate question, it is important to query the patient hemorrhage unless the hemorrhage is simply due to
    about how long individual lesions last, distinct from increased hydrostatic pressure in the lower extremi-
    how long the overall condition has been present. This ties. Urticarial vasculitis and hemorrhagic edema of
    information is often overlooked in emergency depart- infancy often demonstrate associated hemorrhage.
    ment (ED) and urgent care settings.
    How large are the lesions?
    What medications do you take? Small papular wheals (1–4 mm) often suggests cho-
    Most urticarial eruptions represent a hypersensitiv- linergic urticaria, which is related to heat or sweating.
    ity process. These conditions, including urticaria,
    angioedema, serum sickness, and Sweet syndrome, What is the distribution of the lesions?
    may be induced by drugs. Some forms of physical urticaria may demonstrate a
    distinct distribution. For example, solar urticaria is
    Do the lesions itch or are they painful? photoaccentuated, whereas pressure urticaria occurs
    Simple urticaria (hives) is usually pruritic, whereas in areas of pressure, such as the hands, feet, trunk,
    urticarial vasculitis, Sweet syndrome, cellulitis, and buttocks, and legs.
    especially necrotizing fasciitis may be described as
    burning or painful. Is any fever present?
    A fever should prompt consideration of an infectious
    Have you had any difficulty breathing? cause of urticaria (e.g., reaction to streptococcal phar-
    This is a critical question to ask and document in yngitis or a viral infection). Also, some mimics of
    the medical record. Sinopulmonary involvement dis- urticaria may be caused by infection, such as erythema
    tinguishes angioedema and anaphylaxis from simple migrans, the cutaneous manifestation of Lyme disease.

    63

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