Abstract
Urticaria is a common group of dermatologic disorders characterized by hives. Solar urticaria and heat urticaria are two rare types of chronic inducible urticarias. Solar urticaria is triggered by exposure to sunlight or ultraviolet radiation. Heat urticaria is triggered by exposure or contact with a heat stimulus. A 63-year-old woman is described who has both solar urticaria and heat urticaria and the features of these chronic inducible urticarias are reviewed. The woman presented with urticarial lesions that appeared both after exposure to the sun and after cooking at a stove. Additional history revealed she was previously diagnosed with diabetes, hypertension, and thyroid disease. After sun exposure, a punch biopsy of both the affected skin, as well as the normal-appearing skin, was done. Correlation of the clinical history, cutaneous examination, and biopsy examination confirmed the diagnosis of solar urticaria. Treatment of the patient’s urticarias included histamine 1 (H1) and histamine 2 (H2) antihistamines. Her symptoms resolved and did not recur provided that she took the medication as prescribed. Management of chronic urticaria includes not only treatment of the current episode but also prevention of future recurring urticarial lesions. In addition to antihistamines, treatment may include omalizumab (Xolair®) injections for persistent urticaria.
Highlights
Urticaria is a common dermatologic condition characterized by pruritic, erythematous wheals; in addition, it can be accompanied by angioedema of the subcutaneous or interstitial tissue
Heat urticaria is a rare form of chronic inducible urticaria that is characterized by pruritic, erythematous, well-demarcated wheals that form after heat exposure
Physical urticaria is a class of chronic inducible urticaria
Summary
The clinical features of her heat urticaria – erythematous and pruritic periumbilical wheals – are shown (black ovals) on the frontal view of her abdomen She would develop hives in sun-exposed and in sun-covered areas after being outside. Urticarial lesions developed on the legs of a 63-year-old woman after standing outside in a sun-exposed parking lot for 15 minutes with her pants and sandals on (A) Her anterior legs and dorsal feet (B) demonstrate solar urticaria presenting as erythematous, pruritic wheals (black ovals). Correlation of the clinical history, pathologic changes, and laboratory studies established a diagnosis of solar urticaria and heat urticaria Her initial management included histamine 1 (H1) and histamine 2 (H2) antihistamines, fexofenadine 180 milligrams and famotidine 20 milligrams in the morning, and hydroxyzine 10 milligrams and famotidine 20 milligrams in the evenings. She continues to be managed on her current therapy without any additional flares of urticaria
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