Ulcers | Urticaria

An ulcer is a defect in the skin involving the epidermis and dermis. The causes are many:-

Causes

• Trauma

   

  • Physical trauma
  • Pressure as in pressure sores or decubitus ulcers
  • Chemical burns
  • Thermal or radiation burns

   

• Blood disorders

   

  • Sickle-cell anaemia
  • Polycythaemia rubra vera
  • Dysglobulinaemias

   

• Blood vesssel disease

   

  • Arteriosclerosis causing blockage of the arteries
  • Raynaud's syndrome due to spasm of the arteries

   

• Vasculitis
• Varicose ulcer
• Metabolic disorders

   

  • Necrobiosis lipoidica
  • Porphyria cutanea tarda

   

• Neurological disorders causing neuropathic ulcers (ulcers caused by repeated trauma to an area that has lost its sensation of pain as a result of nerve damage).
• Infections

   

  • Bacterial infections such as leprosy, tuberculosis, ecthyma.
  • Deep fungal infections such as chromomycosis, blastomycosis, histoplasmosis and coccidiomycosis.
  • Viral infections such as hand foot and mouth disease and herpes simplex virus infection.

   

• Skin cancers such as squamous cell cancer, basal cell cancer, malignant melanomaand Kaposi's sarcoma
• Other conditions

   

  • Pyoderma gangrenosum
  • Epidermolysis bullosa

  
  What you can do

• You should consult a doctor.

   

  What the doctor may do

• Determine the cause and treat accordingly.

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Urticaria is skin condition characterised by itchy weals that come and go. It is a very common condition and affects at least 20% of individuals at some time during their lives.

Cause
Urticaria is caused by the release of histamine, a chemical cause the blood vessels to leak, leading to fluid accumulating in the skin and causing it to swell. Doctors divide urticaria into acute and chronic cases with 6 weeks as the dividing line.



• Acute urticaria may be caused by:

   

  • Food allergy. This may be caused by any food, including nuts, strawberries and shellfish and food preservatives and colourings.
  • Drug allergy which may be caused by any drug, including x-ray contrast medium, aspirin, codeine, penicillin and sulphonamides.
  • Allergy to insect bites and stings, eg., bees and wasp stings.
  • Hypersensitivity reaction to infections.

Acute urticaria is usually brief and the cause can often be ascertained.

• Chronic urticaria may be caused by:

   

  • Connective tissue disease - sometimes urticaria is a sign of systemic lupus erythematosus or some other connective tissue disease.
  • Hidden or chronic, low-grade infections such as dental abscesses and sinusitis.
  • Parasitic infestations.
  • Physical causes (called physical urticaria):

     

    • Dermographism - induced by stroking or scratching the skin. The weals occur the line of the strokes or scratches.
    • Cholinergic urticaria - induced by sweating.
    • Pressure urticaria - induced by pressure on the skin.
    • Cold urticaria - induced by cold.
    • Heat urticaria - induced by heat.
    • Solar urticaria - induced by ultraviolet light.
    • Aquagenic urticaria - induced by contact with water.
    • Vibratory urticaria - induced by vibration.
    • Pressure urticaria - induced by pressure.
    • Contact urticaria - caused by contact allergy to proteins in animal saliva, meat, fish, plants and vegetables or allergy to chemicals in medicines, cosmetics and white flour.

     

  • Emotional stress
  • Inheritance (inherited angioedema).
  • Allergy to food and food additives, eg., colourings and preservatives.
  • Atopy, ie., an inherited predisposition to atopic dermatitis, asthma (wheezy breathing) and allergic rhinitis (itchy nose) is associated with a greater propensity to develop urticaria.
  • Idiopathic (unknown).

The cause of chronic urticaria is more difficult and in some cases, the cause simply cannot be found despite extensive investigations. This type of urticaria is called idiopathic chronic urticaria.

Symptoms

• Weals or smooth slightly raised patches that are redder or paler than the surrounding skin.
• The weals may be of many different shapes. In dermographism, the weals occur in lines. In cholinergic urticaria, the the weals appear as small red papules (bumps) surrounded by a red flare. In other types of urticaria, the weals may be round, ring-like or map-like.
• The weals are transient, lasting from a few minutes to 24 hours in some. They do not normally leave a mark or stain on the skin when they disappear (contrast with urticarial vasculitis).
• The weals may recur at certain times of the day.
• Severe itching.
• Angioedema is a deeper form of urticaria. It may occur anywhere on the body but is more troublesome when it affects the eyes (causing the eyes to close) and lips, tongue and throat (causing suffocation). Inherited angioedema is caused by a deficiency of a protein called C1 esterase inhibitor and other family members usually suffer from it, as well.

  Urticaria. Click on image for larger view

  Complications

• Anaphylaxis is a severe reaction in which the urticaria is accompanied by chest tightness, wheezing, giddiness and collapse. It may be fatal.
• Angioedema affecting the throat may cause suffocation.

  What you can do

• You should consult a doctor to determine the cause.
• Take antihistamines to control urticaria.
• Apply calamine lotion to relieve itching.
• See a doctor if there is no improvement.
• Go to the nearest Accident and Emergency if urticaria is accompanied by chest tightness, wheezing, difficulty breathing or swallowing, dizziness or faintness and/or swelling of the eyelids, lips or tongue. (see anaphylaxis and angioedema).
• Keep a diary card of items you have taken by mouth or come into contact with. It will help the doctor determine the cause in cases of chronic urticaria.

  What the doctor may do

• Prescribe antihistamines.
• Prescribe oral steroids for severe acute urticaria.
• Hospitalise severe cases for management.
• Conduct tests to determine the cause.
• Recommend elimination diets, if appropriate.
• Prescribe anabolic steroids such as stanazolol and danazol for hereditary angioedema.

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