1
|
Abstract
Ultraviolet light (UV) and visible light are important components in the diagnosis of photodermatoses, and UV has the unique ability to also be used to manage photodermatoses. Phototesting, provocative light testing, and photopatch testing can provide important information in diagnosing patients with photodermatoses; phototesting can be used to determine the starting dose for phototherapy in these patients. Once photosensitivity is established, narrowband UVB and UVA1 therapy have helped to improve the quality of life of photosensitive patients, such as those with polymorphous light eruption, chronic actinic dermatitis, and solar urticaria.
Collapse
Affiliation(s)
- Angela J Jiang
- Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA.
| |
Collapse
|
2
|
Photiou L, Foley P, Ross G. Solar urticaria - An Australian case series of 83 patients. Australas J Dermatol 2018; 60:110-117. [PMID: 30585308 DOI: 10.1111/ajd.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/17/2018] [Indexed: 12/24/2022]
Abstract
Solar urticaria (SU) is a rare form of urticaria with a pathogenesis that is poorly understood. It affects all skin types, can be difficult to diagnose, and is challenging to manage effectively. We conducted a retrospective review of patients with SU in our institution. A total of 83 patients (56 females) were identified as having SU. The mean age was 32 years (7-74) at first development of symptoms/signs of SU. Pruritus was the most common symptom reported (79%). Of the 60 patients who underwent monochromator testing at least once, 35 had SU confirmed with most reacting to visible light and UVA, or to UVA alone. Antihistamines and sun avoidance remain the mainstay treatment for SU but other treatments, including omalizumab, are of potential interest in treating patients with recalcitrant SU. The characterisation of this large case series of patients may help dermatologists recognise and manage this rare disorder appropriately.
Collapse
Affiliation(s)
- Louise Photiou
- St Vincent's Hospital, Melbourne, Victoria, Australia.,The Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Sinclair Dermatology, East Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc, Carlton, Victoria, Australia
| | - Peter Foley
- St Vincent's Hospital, Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc, Carlton, Victoria, Australia.,Department of Dermatology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gayle Ross
- St Vincent's Hospital, Melbourne, Victoria, Australia.,The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
de Gálvez MV, Aguilera J, Sánchez-Roldán C, Herrera-Ceballos E. Infrared radiation increases skin damage induced by other wavelengths in solar urticaria. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 32:284-290. [PMID: 27622861 DOI: 10.1111/phpp.12270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Photodermatoses are typically investigated by analyzing the individual or combined effects of ultraviolet A (UVA), ultraviolet B (UVB), and visible light using light sources that simulate portions of the solar spectrum. Infrared radiation (IRR), however, accounts for 53% of incident solar radiation, but its effects are not taken into account in standard phototest protocols. AIMS The aim was to analyze the effects of IRR, alone and combined with UVA and visible light on solar urticaria lesions, with a distinction between infrared A (IRA) and infrared B (IRB). METHODS We performed standard phototests with UVA and visible light in four patients with solar urticaria and also tested the effects after blocking IRB with a water filter. To analyze the direct effect of IRR, we performed phototests with IRA and IRB. RESULTS Initial standard phototests that were all positive found the induction of erythema and whealing, while when IRR was blocked from the UVA and visible light sources, three of the patients developed no lesions, while the fourth developed a very small wheal. CONCLUSION These results suggest that IRR has the potential to produce and exacerbate lesions caused by other types of radiation. Consideration of these effects during phototesting could help prevent diagnostic errors.
Collapse
Affiliation(s)
- María Victoria de Gálvez
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - José Aguilera
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Cristina Sánchez-Roldán
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Enrique Herrera-Ceballos
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain.,Dermatology Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| |
Collapse
|
4
|
Sánchez-Borges M, González-Aveledo L, Caballero-Fonseca F, Capriles-Hulett A. Review of Physical Urticarias and Testing Methods. Curr Allergy Asthma Rep 2017. [PMID: 28634900 DOI: 10.1007/s11882-017-0722-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review aims to update the information available on the prevalence, clinical picture, diagnostic methods, and treatment of urticarias induced by external physical stimuli. RECENT FINDINGS Physical urticarias are present in up to 5% of the general population, and in 10 to 50% of patients with chronic urticaria. Recent investigations have provided evidence that the presence of physical urticaria alone or when comorbid with chronic spontaneous urticaria is associated with a worse prognosis and duration. Most frequent subtypes of physical urticaria are dermographism and delayed pressure urticaria. The diagnosis is established through specific provocation tests and the management encompasses avoidance measures, pharmacologic therapy with nonsedating antihistamines, and alternative medications in refractory cases.
Collapse
Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela. .,Allergy and Clinical Immunology Service, Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060, Venezuela.
| | | | - Fernan Caballero-Fonseca
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy and Immunology Service, Centro Médico de Caracas, Caracas, Venezuela
| | - Arnaldo Capriles-Hulett
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy and Immunology Service, Centro Médico de Caracas, Caracas, Venezuela
| |
Collapse
|
5
|
Baliu-Piqué C, Aguilera Peiró P. Three cases of solar urticaria successfully treated with omalizumab. J Eur Acad Dermatol Venereol 2015; 30:704-6. [DOI: 10.1111/jdv.13001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Baliu-Piqué
- Dermatology Department; Hospital Clínic de Barcelona; Universitat de Barcelona; Barcelona Spain
| | - P. Aguilera Peiró
- Dermatology Department; Hospital Clínic de Barcelona; Universitat de Barcelona; Barcelona Spain
- Photobiology Unit; Hospital Clínic de Barcelona; Universitat de Barcelona; Barcelona Spain
| |
Collapse
|
6
|
de Gálvez MV, Aguilera J, López N, Herrera E. Delayed-onset solar urticaria with generalized wheals caused by UVB associated with polymorphic light eruption caused by UVA. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 31:107-10. [DOI: 10.1111/phpp.12144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Jose Aguilera
- Department of Dermatology and Medicine; Faculty of Medicine; University of Malaga; Spain
| | - Norberto López
- Dermatology Service; Hospital Clínico Universitario Virgen de la Victoria; Málaga Spain
| | - Enrique Herrera
- Department of Dermatology and Medicine; Faculty of Medicine; University of Malaga; Spain
- Dermatology Service; Hospital Clínico Universitario Virgen de la Victoria; Málaga Spain
| |
Collapse
|
7
|
Severe and refractory solar urticaria treated with intravenous immunoglobulins: A phase II multicenter study. J Am Acad Dermatol 2014; 71:948-953.e1. [DOI: 10.1016/j.jaad.2014.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/22/2022]
|
8
|
|
9
|
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
|
10
|
Contemporary approaches to the diagnosis and management of physical urticaria. Ann Allergy Asthma Immunol 2013; 111:235-41. [PMID: 24054356 DOI: 10.1016/j.anai.2013.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/08/2013] [Accepted: 07/26/2013] [Indexed: 11/22/2022]
|
11
|
Wolf R, Herzinger T, Grahovac M, Prinz JC. Solar urticaria: long-term rush hardening by inhibition spectrum narrow-band UVB 311nm. Clin Exp Dermatol 2013; 38:446-7. [DOI: 10.1111/ced.12048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2012] [Indexed: 12/01/2022]
Affiliation(s)
- R. Wolf
- Department of Dermatology and Allergology; Ludwig-Maximilian University Munich; Munich; Germany
| | - T. Herzinger
- Department of Dermatology and Allergology; Ludwig-Maximilian University Munich; Munich; Germany
| | - M. Grahovac
- Department of Dermatology and Allergology; Ludwig-Maximilian University Munich; Munich; Germany
| | - J. C. Prinz
- Department of Dermatology and Allergology; Ludwig-Maximilian University Munich; Munich; Germany
| |
Collapse
|
12
|
Adamski H, Viguier M. L’urticaire solaire. Ann Dermatol Venereol 2012; 139:324-8; quiz 323, 330. [DOI: 10.1016/j.annder.2012.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/19/2012] [Accepted: 01/31/2012] [Indexed: 11/29/2022]
|
13
|
Update on Photodermatoses. ACTA ACUST UNITED AC 2011; 30:229-38. [DOI: 10.1016/j.sder.2011.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
|
14
|
Duchini G, Bäumler W, Bircher AJ, Scherer K. Failure of omalizumab (Xolair®) in the treatment of a case of solar urticaria caused by ultraviolet A and visible light. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:336-7. [DOI: 10.1111/j.1600-0781.2011.00624.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Duchini
- Dermatology and Allergology; University Hospital Basel; Basel; Switzerland
| | - Wolfgang Bäumler
- Dermatology; University Hospital Regensburg; Regensburg; Germany
| | - Andreas J. Bircher
- Dermatology and Allergology; University Hospital Basel; Basel; Switzerland
| | - Kathrin Scherer
- Dermatology and Allergology; University Hospital Basel; Basel; Switzerland
| |
Collapse
|
15
|
Adamski H, Bedane C, Bonnevalle A, Thomas P, Peyron JL, Rouchouse B, Cambazard F, Jeanmougin M, Viguier M. Solar urticaria treated with intravenous immunoglobulins. J Am Acad Dermatol 2011; 65:336-340. [DOI: 10.1016/j.jaad.2010.05.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/11/2010] [Accepted: 05/20/2010] [Indexed: 11/15/2022]
|
16
|
Narrowband ultraviolet B phototherapy is a suitable treatment option for solar urticaria. J Am Acad Dermatol 2011; 67:e5-9. [PMID: 21620516 DOI: 10.1016/j.jaad.2011.01.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/13/2011] [Accepted: 01/29/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Narrowband (NB) ultraviolet (UV) B lamps are widely used for treatment and prophylaxis of several skin diseases. OBJECTIVE We sought to assess the efficacy of two protocols of NB-UVB therapy for the prophylaxis of UVB-sensitive and UVB-insensitive solar urticaria (SU). METHODS Subjects affected by SU underwent phototesting for assessment of the minimal erythemal dose and minimal urticarial dose. Patients without urticarial response to UVB underwent a single daily exposure every other day for 4 weeks (group A). Patients with a urticarial test response to broadband UVB or NB-UVB (group B) received 3 daily exposures (on working days) for the first week. Afterward, they were treated as the patients of group A for 3 weeks. Follow-up visits took place after 1 and 3 months. RESULTS A total of 39 patients completed the study. In groups A (29 patients) and B (10 patients), the median total number of exposures was 12 (interquartile range [IQR]: 12; 15) and 25.5 (IQR 24; 27), respectively. The median total NB-UVB dose was 10.3 J/cm(2) (IQR 9.9; 11) for group A and 9.1 J/cm(2) (IQR 8.5; 10.6) for group B. At follow-up visits, patients reported good tolerance to the sun. LIMITATIONS A direct comparison of NB-UVB with UVA or psoralen plus UVA for the photoprophylaxis of SU is still lacking. CONCLUSION NB-UVB phototherapy was well-tolerated and effectively prevented SU relapses.
Collapse
|
17
|
Zuberbier T, Asero R, Bindslev‐Jensen C, Walter Canonica G, Church MK, Giménez‐Arnau AM, Grattan CEH, Kapp A, Maurer M, Merk HF, Rogala B, Saini S, Sánchez‐Borges M, Schmid‐Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy 2009; 64:1427-1443. [PMID: 19772513 DOI: 10.1111/j.1398-9995.2009.02178.x] [Citation(s) in RCA: 359] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This guideline, together with its sister guideline on the classification of urticaria (Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: definition, classification and diagnosis of urticaria. Allergy 2009;64: 1417-1426), is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). As members of the panel, the authors had prepared their suggestions regarding management of urticaria before the meeting. The draft of the guideline took into account all available evidence in the literature (including Medline and Embase searches and hand searches of abstracts at international allergy congresses in 2004-2008) and was based on the existing consensus reports of the first and the second symposia in 2000 and 2004. These suggestions were then discussed in detail among the panel members and with the over 200 international specialists of the meeting to achieve a consensus using a simple voting system where appropriate. Urticaria has a profound impact on the quality of life and effective treatment is, therefore, required. The recommended first line treatment is new generation, nonsedating H(1)-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of nonsedating H(1)-antihistamines, it is recommended that second-line therapies should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are most important to consider. Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - R. Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - C. Bindslev‐Jensen
- Allergy Centre, Department of Dermatology, Odense University Hospital, Odense Area, Denmark
| | - G. Walter Canonica
- Allergy and Respiratory Diseases, DIMI – University of Genoa, Genoa, Italy
| | - M. K. Church
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - A. M. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - C. E. H. Grattan
- Dermatology Centre, Norfolk & Norwich University Hospital, Norwich, UK
| | - A. Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - H. F. Merk
- Department of Dermatology, University Hospital RWTH Aachen, Aachen, Germany
| | - B. Rogala
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - S. Saini
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M. Sánchez‐Borges
- Allergy and Immunology Department, Centro Medico‐Docente La Trinidad, Caracas, Venezuela
| | | | - H. Schünemann
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - P. Staubach
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - G. A. Vena
- Department of Dermatology, Johannes Gutenberg‐University Mainz, Mainz, Germany
| | - B. Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany
| | | | | | | | | |
Collapse
|
18
|
|
19
|
Allende I, Gardeazábal J, Lázaro M, Díaz-Pérez J. Problems With Phototesting for the Diagnosis of Solar Urticaria. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
20
|
Botto NC, Warshaw EM. Solar urticaria. J Am Acad Dermatol 2008; 59:909-20; quiz 921-2. [DOI: 10.1016/j.jaad.2008.08.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/18/2008] [Accepted: 08/13/2008] [Indexed: 12/01/2022]
|
21
|
Grundmann S, Ständer S, Luger T, Beissert S. Antihistamine combination treatment for solar urticaria. Br J Dermatol 2008; 158:1384-6. [DOI: 10.1111/j.1365-2133.2008.08543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: prevalence and clinical course. J Dermatol 2007; 34:294-301. [PMID: 17408437 DOI: 10.1111/j.1346-8138.2007.00276.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of our study was to assess the prevalence and clinical course of patients with chronic idiopathic urticaria (CIU), as well as possible causes or associated findings, laboratory findings and the duration of the disease in patients with chronic urticaria (CU). We retrospectively reviewed the 450 case record forms of patients with CU and/or angioedema who attended the Department of Dermatology, Siriraj Hospital, during the period 2000-2004. Of 450 patients with CU, 337 patients (75%) were diagnosed as CIU. Forty-three patients (9.5%) had physical urticaria, while 17 patients (3.8%) had infectious causes. Other possible causes were food, thyroid diseases, atopy, drugs, dyspepsia and collagen vascular diseases. In eighty-nine percent of patients, no abnormalities were detected at the time of physical examination. The most common abnormal laboratory finding was minimal elevation of the erythrocyte sedimentary rate (42%). In 61 patients, autologous serum skin tests had been done. Fifteen patients (24.5%) had positive results i.e. autoimmune urticaria. Anti-thyroglobulin and anti-microsomal antibodies were positive in 16 % and 12% of CIU patients respectively. After 1 year from the onset of the symptoms, 34.5% of CIU patients were free of symptoms and after 1.2 years from the onset of the symptoms, 56.5% of autoimmune urticaria patients were free of symptoms. The median disease duration of CIU and autoimmune urticaria were 390 days and 450 days respectively. Our study provided an overview of CU and CIU in a large series of Thai patients, based on etiological aspects and clinical courses.
Collapse
Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
| | | | | | | |
Collapse
|
23
|
Abstract
Non-hereditary photodermatoses with well-known trigger factors and idiopathic light eruptions occur quite frequently during childhood and are at least temporarily associated with a marked impairment of quality of life in affected patients and their parents. Thus, it is crucial that the involved specialties are familiar with acquired UV-associated disorders in order to guarantee a quick diagnosis and effective therapy. Additionally, the recurrence of photodermatoses associated with potentially severe long-term complications has to be prevented. This requires a stringent prophylaxis that can only succeed after age-adapted instruction of the patient and parents.
Collapse
Affiliation(s)
- H Ott
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Aachen, Pauwelsstrasse 30, 52074 Aachen.
| | | |
Collapse
|
24
|
Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CEH, Greaves MW, Henz BM, Kapp A, Kozel MMA, Maurer M, Merk HF, Schäfer T, Simon D, Vena GA, Wedi B. EAACI/GA2LEN/EDF guideline: management of urticaria. Allergy 2006; 61:321-31. [PMID: 16436141 DOI: 10.1111/j.1398-9995.2005.00962.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This guideline is the result of a consensus reached during a panel discussion at the second International Consensus Meeting on Urticara, Urticaria 2004, a joint initiative of the EAACI Dermatology Section and GA2LEN. Urticaria has a profound impact on the quality of life, and effective treatment is therefore required. The recommended first line treatment are nonsedating H1 antihistamines. They have proven to be effective in double-blind controlled studies, but dosages increased up to fourfold over the recommended doses may be necessary. However, for different urticaria subtypes and in view of individual variation in the course of the disease and response to treatment, additional or alternative therapies may be required. Immunosuppressive drugs like cyclosporin A and corticosteroids are not recommended for long-term treatment due to unavoidable severe adverse effects. This guideline was, in addition, accepted by the European Dermatology Forum (EDF) and formally approved by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Rose RF, Bhushan M, King CM, Rhodes LE. Solar angioedema: an uncommonly recognized condition? PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2006; 21:226-8. [PMID: 16149933 DOI: 10.1111/j.1600-0781.2005.00175.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Solar urticaria is a well defined although uncommon photosensitivity disorder, and is said to be the underlying cause of chronic urticaria in approximately 0.5% cases. In contrast, solar angioedema is seldom reported. We describe two patients with postulated solar angioedema, associated with clinical and/or phototest features of solar urticaria. Recognition of solar provocation of angioedema has important consequences for patient management.
Collapse
Affiliation(s)
- R F Rose
- Photobiology Unit, Dermatology Centre, University of Manchester School of Medicine, Manchester, UK
| | | | | | | |
Collapse
|
26
|
Eguino P, Lasa O, Gardeazábal J, Díaz-Pérez JL. Urticaria solar. Estudio de 20 casos. ACTAS DERMO-SIFILIOGRAFICAS 2005; 96:25-9. [PMID: 16476328 DOI: 10.1016/s0001-7310(05)73028-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Solar urticaria is an infrequent disorder, but is probably underdiagnosed. It is characterized by the sudden appearance of weals in areas that are not usually photoexposed after exposure to the sun or to artificial sources of visible or ultraviolet light. Few cases have been published in literature, so the information available about this disorder and its natural evolution is limited. MATERIAL AND METHODS We have compiled data from 20 patients diagnosed with solar urticaria in our department in the last 12 years (1990-2002) in order to try to obtain information about the characteristics of this condition. RESULTS As the most relevant characteristics of our series, we can mention the fact that 60 % of the patients were women, and the average duration of the condition before consulting a dermatologist was 3 years. In 55 % of the patients, areas that are usually photoexposed, such as the face and hands, were less severely affected (due to acclimatization or hardening). The spectra responsible for the SU were visible light, UVA and UVB, in that order. With regard to treatment, we obtained a partial response with antihistamines and photoprotectors, and good results using progressive desensitization with UVA/sunlight. CONCLUSION Solar urticaria is probably an underdiagnosed condition in our milieu. There are few series in literature that provide any information about the most significant characteristics of this disorder. We have compiled the most relevant data from our patients and we have compared it with the other published series in an attempt to learn more about this photodermatosis.
Collapse
Affiliation(s)
- Patricia Eguino
- Servicio de Dermatología, Hospital de Cruces, Pza. de Cruces s/n, 48903 Barakaldo, Vizcaya, Spain.
| | | | | | | |
Collapse
|