DELAYED PRESSURE URTICARIA

By Gary M. White, MD


Delayed pressure urticaria is one of the pressure urticarias in which urticarial wheals develop 4-8 hours after pressure has been applied to the skin.

Clinical

The lesions may be wheals or deep-seated swellings of the skin in areas of pressure, e.g. the waist band, buttocks, palms, soles. One of my patients experienced swelling of the hips every time he wore heavy pants or carried bulky items in his pockets. In a review of 17 patients, [Dermatol Ther. 2015 Jul 2], the average age was 43 years with 10 women and seven men.

Treatment

Standard antihistamines may be tried, e.g. cetirizine 10-20 mg QD-BID.

Sulfasalazine

In the above report [Dermatol Ther. 2015 Jul 2], none of the 17 patients responded well to oral antihistamines, but all 17 responded transiently when treated with either oral or intramuscular steroids. Eleven patients experienced complete or near complete resolution with sulfasalazine.

Omalizumab may be helpful [Allergol Immunopathol (Madr). 2014 Jan-Feb;42(1):78-80]. Dapsone has been recommended [J Dtsch Dermatol Ges. 2011 Nov;9(11):908-12.]. See urticaria for more options.

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