Urticaria: an update on diagnostics, therapy, and differential diagnosis

Abstract

Urticaria is a common skin disorder that can occur at any age; middle-aged women are most commonly affected. The diagnosis of urticaria is straightforward: the clinical picture includes wheals and/or angioedema accompanied by extreme itch. As a general rule, a wheal lasts for up to 1 day, whilst mast cell-mediated angioedema can remain symptomatic for up to 2 days. A distinction is made between acute and chronic forms (≥6 weeks), whereby symptoms may be present every day. Relapsing disease courses have also been described. This paper presents a current overview.

Urticaria requires a detailed patient history and appropriate diagnostic methods in order to establish the diagnosis accurately. There are more than 10 subtypes of this disorder, which can also occur as a combined form. A distinction is made between two main groups: spontaneous and inducible forms of urticaria. Acute urticaria is the most common form. A search for the cause is only necessary in the case of long-term and severe disease. The symptomatic treatment of urticaria should be performed parallel to the search for its cause. Any possible causes/trigger factors that are identified can be treated/remedied or eliminated. Urticaria then resolves or regresses after only a few weeks. Spontaneous remissions are possible. Only one extremely rare subgroup of cold urticaria shows a familial aggregation. No other forms of urticaria are inherited.