Journal of the American Academy of Dermatology
Volume 62, Issue 4 , Pages 541-555 , April 2010

Urticarial lesions: If not urticaria, what else? The differential diagnosis of urticaria: Part I. Cutaneous diseases

  • Anna Peroni, MD

      Affiliations

    • Department of Biomedical and Surgical Sciences, Section of Dermatology and Venereology, University of Verona, Verona, Italy
    • Department of Pathology, Section of Immunology, University of Verona, Verona, Italy
  • ,
  • Chiara Colato, MD

      Affiliations

    • Department of Pathology, Section of Pathology, University of Verona, Verona, Italy
  • ,
  • Donatella Schena, MD

      Affiliations

    • Department of Biomedical and Surgical Sciences, Section of Dermatology and Venereology, University of Verona, Verona, Italy
  • ,
  • Giampiero Girolomoni, MD

      Affiliations

    • Department of Biomedical and Surgical Sciences, Section of Dermatology and Venereology, University of Verona, Verona, Italy
    • Corresponding Author InformationCorrespondence to: Giampiero Girolomoni, MD, Clinica Dermatologica, Università di Verona, Piazzale A. Stefani 1, 37126 Verona, Italy.

References 

  1. Schocket AL. Chronic urticaria: pathophysiology and etiology, or the what and why. Allergy Asthma Proc. 2006;27:90–95
  2. Kaplan AP, Greaves M. Pathogenesis of chronic urticaria. Clin Exp Allergy. 2009;39:777–787
  3. Zuberbier T, Asero R, Bindslev-Jensen C, Canonica W, Church MK, Giménez-Arnau A, et al. EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64:1417–1426
  4. Zuberbier T, Maurer M. Urticaria: current opinions about etiology, diagnosis and therapy. Acta Derm Venereol. 2007;87:196–205
  5. Kukthanan K, Chiawsirikajorn Y, Jamton S. Acute urticaria: etiologies, clinical course and quality of life. Asian Pac J Allergy Immunol. 2008;26:1–9
  6. Mathelier-Fusade P. Drug-induced urticarias. Clin Rev Allergy Immunol. 2006;30:19–23
  7. Nasser SMS, Ewan PW. Opiate sensitivity: clinical characteristics and the role of skin prick testing. Clin Exp Allergy. 2001;31:1014–1020
  8. Liu TH, Lin YR, Yang KC, Chou CC, Chang YJ, Wu HP. First attack of acute urticaria in pediatric emergency department. Pediatr Neonatol. 2008;49:58–64
  9. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2008;121:S402–S407
  10. Lieberman P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2008;8:316–320
  11. Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000;105:664–672
  12. Asero R, Riboldi P, Tedeschi A, Cugno M, Meroni P. Chronic urticaria: a disease at a crossroad between autoimmunity and coagulation. Autoimmun Rev. 2007;7:71–76
  13. Baiardini I, Pasquali M, Braido F, Fumagalli F, Guerra L, Compalati E, et al. A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL). Allergy. 2005;60:1073–1078
  14. Dice JP. Physical urticaria. Immunol Allergy Clin North Am. 2004;24:225–246
  15. Siebenhaar F, Weller K, Mlynek A, Magerl M, Altrichter S, Vieira Dos Santos R, et al. Acquired cold urticaria: clinical picture and update on diagnosis and treatment. Clin Exp Dermatol. 2007;32:241–245
  16. Lawlor F, Black AK. Delayed pressure urticaria. Immunol Allergy Clin North Am. 2004;24:247–258
  17. Botto NC, Warshaw EM. Solar urticaria. J Am Acad Dermatol. 2008;59:909–920
  18. Tharp MD. Chronic urticaria: pathophysiology and treatment approaches. J Allergy Clin Immunol. 1996;98:S325–S330
  19. Sabroe RA, Poon E, Orchard GE, Lane D, Francis DM, Barr RM, et al. Cutaneous inflammatory cell infiltrate in chronic idiopathic urticaria: comparison of patients with and without anti-FcεRI or anti-IgE autoantibodies. J Allergy Clin Immunol. 1999;103:484–493
  20. Fujii K, Konishi K, Kanno Y, Ohgou N. Acute urticaria with elevated circulating interleukin-6 is resistant to anti-histamine treatment. J Dermatol. 2001;28:248–250
  21. Deacock SJ. An approach to the patient with urticaria. Clin Exp Immunol. 2008;153:151–161
  22. Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37:631–650
  23. Tedeschi A, Girolomoni G, Asero R. AAITO committee for chronic urticaria and pruritus guidelines. AAITO position paper. Chronic urticaria: diagnostic workup and treatment. Eur Ann Allergy Clin Immunol. 2007;39:225–231
  24. Kozel MMA, Mekkes JR, Bossuyt PMM, Bos JD. The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema. Arch Dermatol. 1998;134:1575–1580
  25. Doutre MS. Chronic urticaria and thyroid auto-immunity. Clin Rev Allergy Immunol. 2006;30:31–37
  26. Sabroe RA, Flebiger E, Francis DM, Maurer D, Seed PT, Grattan CEH, et al. Classification of anti-FcεRI and anti IgE autoantibodies in chronic urticaria and correlation with disease severity. J Allergy Clin Immunol. 2002;110:492–499
  27. Asero R, Tedeschi A, Ribaldi P, Cugno M. Plasma of patients with chronic urticaria shows signs of thrombin generation, and its intradermal injection causes wheal-and-flare reactions much more frequently than autologous serum. J Allergy Clin Immunol. 2006;117:1113–1117
  28. Fung MA. The clinical and histopathologic spectrum of “dermal hypersensitivity reactions,” a nonspecific histologic diagnosis that is not very useful in clinical practice, and the concept of a “dermal hypersensitivity reaction pattern.”. J Am Acad Dermatol. 2002;47:898–907
  29. Kossard S, Hamann I, Wilkinson B. Defining urticarial dermatitis: a subset of dermal hypersensitivity reaction pattern. Arch Dermatol. 2006;142:29–34
  30. Rietschel RL. A clinician's view of urticarial dermatitis. Arch Dermatol. 2006;142:932
  31. Kossard S, Hamann I. A clinician's view of urticarial dermatitis. Reply. Arch Dermatol. 2006;142:932–933
  32. Coenraads PJ, Goncalo M. Skin diseases with high public health impact. Contact dermatitis. Eur J Dermatol. 2007;17:564–565
  33. Diepgen TL, Weisshaar E. Contact dermatitis: epidemiology and frequent sensitizers to cosmetics. J Eur Acad Dermatol Venereol. 2007;21(Suppl):9–13
  34. Fyhrquist-Vanni N, Alenius H, Laurema A. Contact dermatitis. Dermatol Clin. 2007;25:613–623
  35. Rietschel RL, Fowler JF. Contact urticaria. In:  Rietschel RL,  Fowler JF editor. Fisher's contact dermatitis. 5th ed. Philadelphia (PA): Lippincott William & Wilkins; 2001;p. 581–604
  36. Mowad CM, Marks JG. Allergic contact dermatitis. In:  Bolognia JL,  Jorizzo JL,  Rapini RP editor. Dermatology. St Louis: Mosby; 2003;p. 227–240
  37. Cohen DE, Bassiri-Tehrani S. Irritant contact dermatitis. In:  Bolognia JL,  Jorizzo JL,  Rapini RP editor. Dermatology. St Louis: Mosby; 2003;p. 241–249
  38. Steen CJ, Janniger CK, Schutzer SE, Schwartz RA. Insect sting reactions to bees, wasps, and ants. Int J Dermatol. 2005;44:91–94
  39. Moffit JE, Golden DBK, Reisman RE, Lee R, Nicklas R, Freeman T, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol. 2004;114:869–886
  40. Ellis AK, Day JH. Clinical reactivity to insect stings. Curr Opin Allergy Immunol. 2005;5:349–354
  41. Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin, nail and hair disorders. Drug Saf. 2007;30:1011–1030
  42. Briley LD, Phillips CM. Cutaneous mastocytosis: a review focusing on the pediatric population. Clin Pediatr. 2008;47:757–761
  43. Yanagihori H, Oyama N, Nakamura K, Kaneko F. C-kit mutations in patients with childhood-onset mastocytosis and genotype-phenotype correlation. J Mol Diagn. 2005;7:252–257
  44. Shaffer HC, Parsons DJ, Peden DB, Morrel D. Recurrent syncope and anaphylaxis as presentation of systemic mastocytosis in a pediatric patient: case report and literature review. J Am Acad Dermatol. 2006;54:S210–S213
  45. Paynel V, Kam PCA. Mast cell tryptase: a review of its physiology and clinical significance. Anaesthesia. 2004;59:695–703
  46. Escribano L, Alvarez-Twose I, Sanchez-Muñoz L, Garcia-Montero A, Nùñez R, Almeida J, et al. Prognosis in adult indolent systemic mastocytosis: a long-term study of the Spanish Network on Mastocytosis in a series of 145 patients. J Allergy Clin Immunol. 2009;124:514–521
  47. Brockow K, Jofer C, Behrendt H, Ring J. Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy. 2008;63:226–232
  48. Gobello T, Mazzanti C, Sordi D, Annessi G, Abeni D, Chinni ML, et al. Medium versus high dose ultaviolet A1 phototherapy for urticaria pigmentosa: a pilot study. J Am Acad Dermatol. 2003;49:679–684
  49. Olasz EB, Yancey KB. Bullous pemphigoid and related subepidermal autoimmune blistering diseases. Curr Dir Autoimmun. 2008;10:141–166
  50. Di Zenzo G, Marazza G, Borradori L. Bullous pemphigoid: physiopathology, clinical features and management. Adv Dermatol. 2007;23:257–288
  51. Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: An evidence-based systematic review. Am J Obstet Gynecol. 2003;188:1083–1092
  52. Al-Fouzan AWS, Galadari I, Oumeish I, Oumeish OY. Herpes gestationis (Pemphigoid gestationis). Clin Dermatol. 2006;24:109–112
  53. Guide SV, Marinkovich MP. Linear IgA bullous dermatosis. Clin Dermatol. 2001;19:719–727
  54. Kolanko E, Bickle K, Keehn C, Glass LF. Subepidermal blistering disorders: a clinical and histopathologic review. Semin Cutan Med Surg. 2004;23:10–18
  55. Robinson ND, Hashimoto T, Amagai M, Chan LS. The new pemphigus variants. J Am Acad Dermatol. 1999;40:649–671
  56. Kárpáti S. Dermatitis herpetiformis: close to unraveling a disease. J Dermatol Sci. 2004;34:83–90
  57. Rudolph CM, Al-Fares S, Vaughan-Jones SA, Müllegger RR, Kerl H, Black MM. Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. Br J Dermatol. 2006;154:54–60
  58. Matz H, Orion E, Wolf R. Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP). Clin Dermatol. 2006;24:105–108
  59. Cohen LM, Capeless EL, Krusinski PA, Maloney ME. Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal-fetal weight gain and twin pregnancy. Arch Dermatol. 1989;125:1534–1536
  60. Cocuroccia B, Gisondi P, Gubinelli E, Girolomoni G. Autoimmune progesterone dermatitis. Gynecol Endocrinol. 2006;22:54–56
  61. Baptist AP, Baldwin JL. Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature. Clin Mol Allergy. 2004;2:10
  62. Bolaji II, O'Dweyer EM. Post-menopausal cyclic eruptions: autoimmune progesterone dermatitis. Eur J Obstet Gynecol Reprod Biol. 1992;47:169–171
  63. Stranahan D, Rausch D, Deng A, Gaspari A. The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis. Dermatitis. 2006;17:39–42
  64. Snyder JL, Krishnaswamy G. Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review. Ann Allergy Asthma Immunol. 2003;90:469–477
  65. Kasperska-Zajac A, Brzoza Z, Rogala B. Sex hormones and urticaria. J Dermatol Sci. 2008;52:79–86
  66. Grabmeier B, Landthaler M, Hohenleutner S. The menstrual cycle and the skin. J Dtsch Dermatol Ges. 2005;3:52–63
  67. Shelley WB, Shelley ED, Talanin NY, Santoso-Pham J. Estrogen dermatitis. J Am Acad Dermatol. 1995;32:25–31
  68. Murano K, Koyano T. Estrogen dermatitis that appeared twice in each menstrual period. J Dermatol. 2003;30:719–722
  69. Ackerman AB, Guo Y, Vitale P, Vossaert K. Clues to diagnosis in dermatopathology. Chicago (IL): American Society of Clinical Pathologists Press; 1993;pp. 309-12
  70. Tomasini C, Pippione M. Interstitial granulomatous dermatitis with plaques. J Am Acad Dermatol. 2002;46:892–899
  71. Verneuil L, Dompmartin A, Comoz F, Pasquier CJ, Leroy D. Interstitial granulomatous dermatitis with cutaneous cords and arthritis: A disorder associated with autoantibodies. J Am Acad Dermatol. 2001;45:286–291
  72. Comte C, Guillot B, Durand L, Picot E, Dereure O. Interstitial granulomatous dermatitis with arthritis: four cases. Ann Dermatol Venereol. 2008;135:38–43
  73. Schreckenberg C, Asch PH, Sibilia J, Walter S, Lipsker D, Heid E, et al. Interstitial granulomatous dermatitis and paraneoplastic rheumatoid polyarthritis disclosing cancer of the lung. Ann Dermatol Venereol. 1998;125:585–588
  74. Crowson AN, Magro C. Interstitial granulomatous dermatitis with arthritis. Hum Pathol. 2004;35:779–780
  75. Long D, Thiboutot DM, Majeski JT, Vasily DB, Helm KF. Interstitial granulomatous dermatitis with arthritis. J Am Acad Dermatol. 1996;34:957–961
  76. Wells GC, Smith NP. Eosinophilic cellulitis. Br J Dermatol. 1979;100:101–109
  77. Weiss G, Shemer A, Confino Y, Kaplan B, Trau H. Wells' syndrome: report of a case and review of the literature. Int J Dermatol. 2001;40:148–152
  78. Feliciani C, Motta A, Tortorella R, De Benedetto A, Amerio P, Tulli A. Bullous Wells' syndrome. J Eur Acad Dermatol Venereol. 2006;20:1021–1022
  79. Moossavi M, Mehregan DR. Wells' syndrome: a clinical and histopathologic review of seven cases. Int J Dermatol. 2003;42:62–67
  80. Seçkin D, Demirhan B. Drugs and Wells' syndrome: a possible causal relationship?. Int J Dermatol. 2001;40:138–140
  81. Bachmeyer C, Aractingi S. Neutrophilic eccrine hidradenitis. Clin Dermatol. 2000;18:319–330
  82. Bilic M, Mutasim DF. Neutrophilic eccrine hidradenitis in a patient with Behçet's disease. Cutis. 2001;68:107–111
  83. Roustan G, Salas C, Cabrera R, Simòn A. Neutrophilic eccrine hidradenitis unassociated with chemotherapy in a patient with acute myelogenous leukemia. Int J Dermatol. 2001;40:144–147
  84. Enjolras O, Guillemette J, Hewitt J. Urticaria-like follicular mucinosis. [in French, (author's transl)] Ann Dermatol Venereol. 1980;107:491–495
  85. Crovato F, Nazzari G, Nunzi E, Rebora A. Urticaria-like follicular mucinosis. Dermatologica. 1985;170:133–135

 Funding sources: None.

 Conflicts of interest: The authors, editors, and peer reviewers have no relevant financial relationships.

 Reprints not available from the authors.

PII: S0190-9622(09)02291-9

doi: 10.1016/j.jaad.2009.11.686

Journal of the American Academy of Dermatology
Volume 62, Issue 4 , Pages 541-555 , April 2010