LETS SEE what it is
Nettle rash; Hives ; Weals.
Urticaria is a commonly seen clinical condition where there is a transient eruption of raised and circumscribed erythematous or oedematous swellings of the superficial dermis, associated with itching
There are a variety of its clinical variants seen, two of which are:
· Angioedema (angioneurotic oedema, giant urticaria, Quinke’s oedema) Consists of transient swellings in the deeper dermal, subcutaneous and Submucosal tissues. Urticaria and angioedema often occur together and for practical purposes are similar processes. However, the form of pure angioedema that is caused by CI esterase inhibitor deficiency shows some differences clinically and in response to treatment.
Systemic anaphylaxis is an acute life- threatening condition induced by an IgE- medicated allergic reaction. It consists of a combination of symptoms and signs including diffuse erythema, pruritus, urticaria, angioedema, hypotension and cardiac arrhythmias. A similar clinical picture from non- allergic causes is called a systemic anaphylactoid reaction.
Classification & Etiology
Urticaria can be broadly classified in terms of ‘duration’ or its ‘trigger factors’.
1. In terms of duration, Urticaria can be divided into acute and chronic forms. Acute Urticaria is usually self- limited and the weals commonly resolve within 24 hours, but may last up to 4- 6 weeks. In chronic urticaria the weals continue daily or on most days for longer than 6 weeks. Acute urticarias are more common in young adults of both sexes, whereas chronic urticarias are more commonly seen in women, in their fourth or fifth decades. A cause or trigger factor can be easily found in acute urticaria, as compared to the chronic form.
2. When classified in terms of trigger factors, it can be divided into:
a. Nonimmunologic or nonallergic or ordinary urticaria:
These are caused by degranulation of mast cells and hista-mine release by mechanisms not involving antigen- anti- body reaction. The most commonly seen causative factors of nonallergic urticaria are:
* Drugs: Anesthetics, angiotensin converting enzyme in- hibitors, aspirin and other non- steroidal anti- inflammatory drugs, codeine, morphine, penicillin, cephalospor-ins, sulfonamides and other antibiotics, diuretics, iodides, bromides, quinine, vancomycin, isoniazid and antiepileptic agents.
* Food: Chocolates, eggs, fish milk and products, nuts, pork, shellfish, strawberries, tomato, and yeast.
* Food additives: Hydroxybenzoates, salicylates, sulhites, and tartrazine.
* Inhalants: Animal danders, grass pollens, house dust, mould spores, new perfumes.
* Infections: Pharyngitis, gastrointestinal, genitourinary, respiratory, fungal (e.g., scabies), HIV and parasitic infections (e.g., ascaris, strongyloides, schistosoma, and trichinella).
* Systemic disorders: Amyloidosis, carcinoma, hyperthy- roidism, lymphoma, polycythemia vera, polymyositis, rheumatic arthritis (RA), and SLE
* Physical: Cold, exercise, friction, perspiration, pressure, and sunlight.
* Miscellaneous: Contact with nickel (e.g., cheap jewelry, jean stud buttons), latex, nail polish or rubber (e.g., gloves and elastic bands); emotional or physical stress; pregnancy (usually occurs in last trimester and typically resolves spontaneously soon after delivery); and recent use of new clothes, creams, detergents, or lotions.
b. Immunlogic or allergic or idiopathic or autoimmune urticaria: Genes
tend to play a role in a few urticarial conditions, where a strong personal or
family history of atopic disorders can usually be found. Angioedema and a
few rare urticarial variants can be of a hereditary type occurring due to a
CI esterase inhibitor deficiency.
- The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, and resulting in an oedema which persists until the interstitial fluid is absorbed into the surrounding cells.
- Urticarial disease is thought to be caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or non-allergic reaction, differing in the eliciting mechanism of histamine release.
Neuropeptides have been found to be involved in emotionally induced urticaria.
Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria and erythropoietic protoporphyria) have been associated with solar urticaria.
Drug-induced solar urticaria should be investigated for porphyrias. Caused by IgG binding not IgE
The urticarial lesions begins as itchy erythematous macules, which develop into weals consisting of pale-pink or red, oedematous, raised skin areas, of varying shapes and sizes, often with a surrounding flare. These usually transient and migratory lesions can form linear, annular (circular) or actuate (serpiginous) patterns, and can occur anywhere on the body in variable numbers. These wheals are generally very itchy, especially at night, but the patients tend to usually rub the part, rather than scratch and thus these lesions resolve leaving a normal skin surface, without any excoriation marks. In a number of cases, these weals are seen to get worse in the evenings or nights and also usually before menses. Urticarial vasculitis should be suspected if the lesions last for more than 24 hours.
Half the cases of urticaria are associated with angioedema, where large, non-pruritic or slightly itchy, non-pitting, pale or pink, diffuse swellings occur, especially on the face, affecting the eyelids, lips, tongue, pharynx and larynx, hands, feet, genitalia,ears,and neck. These lesions may last for several days.
In a few cases urticaria or angioedema can be associated with systemic symptoms like malaise, fever, headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, arthralgia, feeling of a lump in the throat, hoarseness, wheezing, shortness of breath, and syncope, and in its most severe acute from with anaphylaxis.
Specific laboratory studies are not generally indicated. Instead a detailed personal and family case history is taken in suspected clinical cases, especially as regards to pervious attacks, and an attempt made to find out the trigger factors, through in more than half the cases no particular cause can be traced.
In few cases a fluoroimmunoassay may help in detection of food allergies undetected by routine examination and testing.
* Erythema multiforme.
Education on avoidance of the suspected offending allergen is essential.
In cases of angioedema or anahylaxis, timely emergency care needs to be taken in a hospital setting, with checking of vital statistics and checking for air flow in the respiratory passage, and if needed administering oxygen. In a few cases, intubation or even tracheostomy may be required, where there is laryngeal obstruction due to angioedema.
Homeopathic Approach to Urticaria
Homeopathy has maximum scope in the above condition, as modern medicine has nothing more to offer other than antihistaminics.
The following pattern should be observed most meticulously whilst treating the patient:
* Confirm whether the lesions fits into urticarial rash. The typical lesion should include a rosy – red, erythematous macule with edematous weals. The erythema fades on pressure.
* Time of aggravation. I have found a night aggravation more common.
* Dose urticaria alternate with any other complaint? Especially asthma or rheumatism.
* Always ask whether urticaria is preceded by any other symptoms like nausea, chill, menses, etc.
* Inquire as to which season the patients develops urticaria and at what temperature e.g. hot room, cold room, open air, near the seashore, etc.
* The most important factor that helps us to eliminate majority of the drugs is the patient’s feeling of wellbeing after an application of heat or cold.
* Try and find out which particular foodstuff aggravates the condition, especially shellfish, sweets, meat, chocolates, etc.
* Has the patient got any emotional stress?
* I have seen many patients of urticaria who have a history of worm infestation. Therefore one should inquire for any history of worms. Also history of insects bites or contact with any plants or ingestion of drugs like penicillin or salicylates.
* Sometimes physical factors especially exposure to sun, excessive physical exertion and exercise lead to urticaria.
All the above should be thoroughly scrutinized to get the maximum data. In very rare cases, patient may develop swelling of face with laryngeal obstruction. At that time the patient should be shifted to a homeopathic hospital and his airway should be kept clear with endotracheal intubation and oral drugs like chlorum, etc. should be administered
The treatment consists of not only giving the indicated homeopathic drugs, but to eliminate the offending agent e.g. eliminative diet, withdrawal of causative drug, treatment of parasitic infection, correction of the existing physical stress. During an acute attack the patient should be kept on a bland diet- alcohol, tea and coffee are preferably avoided. Finally reassurance should be given to the patients who have chronic urticaria.
Some Important Homeopathic Remedies and Certain Important Rubrics Helpful in Clinical practice
Astacus fluviatilis, Bacillus proteus, Bombyx, Chloralum hydratum. Medusa, Santoninum, Tilia, Boletus luridus, Copaiva.
- Urticaria wrose at night: Apis, Bov, Chlol, Cop.
- Urticaria alternating with asthma: Apis.
- Giant urticaria: Lyc, Stroph-h.
- Chronic urticaria: Hygroph-s.
- Urticaria during fever: Rhus-t.
- Extremely giant urticaria: Antip, Bacillus no. 7, Bol-lu, Santin.
- Urticaria associated with lot of Edema: Cortico.
Drugs for Acute Urticaria
Anthracokali: Urticaria increases with general sweat. There is intense itching, which is
Aresenicum album: Urticaria with burning and restlessness. Useful for persistence of complaints during recession of urticaria.
Copaiva officinalis: Hives with fever and constipation. Chronic urticaria in children. Itching < at night and during fever. Urticaria over whole body with red face. Skin dry and hot with violent itching. Severe headache with urticaria.
Dulcamara: Hives comes on at night, especially when nights are cool, with heavy dew, after a hot day or when weather changes from warn to cool and damp. Urticaria with violent cough and edema of glands. Feverish urticaria. Urticaria obliging one to scratch and burning after scratching, every eruption being preceded by sensation of pricking over whole body. Eruption of white, irregular blotches raised upon the skin, surrounded with red areola, appearing in warmth and disappearing in cold. Extremities, face, chest and back violently itching and burning after scratching. Headache, want of appetite, nausea, bitter taste, vomiting, intense aching in pit of stomach and precordial region, restlessness and sleeplessness, night sweats, turbid dark urine, diarrhea, pains in limbs. Urticaria from gastric disorders.
Ichthyolum: Chronic urticaria in patients of uric acid or tuberculous diathesis. Urticaria seen in alcoholics and especially in old people. Most important concomitant is intense appetite.
Medusa: face, arms shoulders and breasts. Oedema – face, eyes, nose, ears and lips. Burning, pricking, itching sensation associated with urticaria.
- from emotion: Anac, Bov, Ign, Kali-br.
- From exertion: Con, Nat-m, Pso, Urt-u.
- With oedema: Apis.
- From menstrual condition: Cim, Dulc, Kali-c, Puls.
- From shellfish, roe: Camph.
- From suppressed malaria: Elat.
- From Sweat: Apis, Rhus-t.
- With Catarrh: Cepa, Dulc.
- With Constipation, fever: Cop.
- With Croup, alternating: Ars.
- Alternating with Asthma: Calad.
- Alternating with rheumatism: Urt-u.
- Asthmatic troubles in : Apis.
- With erosion on toes: Sulph.
- With itching, burning, often scratching, no fever: Dulc.
- With Liver Disturbance: Astac.
- With Petechial disturbance or erysipelatous eruption: Fragar.
- With rheumatic lameness, palpitation, diarrhea: Bov, Dulc.
- With sequel from suppressed hives: Apis, Urt.
- With coming sudden & going: Antipy
- Wine from: Chlol.
- At Climacteric - Morph, Ustil.
- At menstrual periord: Cim, Dulc, Kali-c, Mag-c.
- At night: Ant-c, Ars.
- From bathing, walking in A.M. : Bov.
- From cold: Ars, Dulc, Rhus -t, Rum, Sep.
- From exertion, exercise: Con, Nat-m, Psor, Urt-u.
- From Open air: Nit. acid, Sep.
- From wine: Chlol.
- In Children: Cop.
- Periodical - every year: Urt- u.
- Cold water : Apis, Dulc.
- Hot drinks: Chloral.
- From Open air: Calc.
- From warmth: Ars, Chloral,
< heat & cold bathing, evening, acids.
> open air, rest, moist air.
< by heat in any form; touch, pressure; late in afternoon; after sleeping; in closed and heated rooms, Right side.
> in open air, uncovering, and cold bathing.
< walking in morning, from bathing.
Asthma or Respiratory symptoms alternates with Urticaria.
< wet weather, after midnight, from cold, coold drinks, cold food, cold season.
> from heat, warm drinks.
< application of hot water.
< after sweat, after sleep in daytime.
< motion, night, contact, cold air.
< after hot drinks, stimulants, night
< at night, from cold in general, damp, rainy weather.
> from moving about, external warmth.
< draft of air, morning, open air.
< at seashore, mental exertion, heat.
> open air, cold bath.
Burning pain < night.
Useful for Urticaria after eating rich food. Urticaria with Diarrhoea. Urticaria from delayed menses. < undressing.
< from heat, rich fat food, after eating, towards evening, warm room.
> open air, motion, cold application, cold food & drinks.
> warm, dry weather.
Urticaria with itching, burning < scratching & washing.
< warmth, evening, spring time, damp weather.
> dry, warm weather.
Useful for Urticaria nodosa. Also for Urticaria with angioneorotic odema.
< snow air, water, cool moist air, touch.
~ DR AJAY YADAV
skin homeopathy approch to dermatology from F .J MASTER
skin disease and homeopathy therapetics J.H ALLEN
PHATAK MATERIA MEDICA
reperty added by dr r SARSWAT
by Oscar E. BOERICKE, M.D.
Emotion [from] -- Anac., Bov., Ign., Kali br.
Exertion, excessive [from] -- Con., Nat. m.
Exposure [from] -- Chloral., Dulc., Rhus t.
Gastric derangement [from] -- Ant. c., Ars., Carbo v., Cop., Dulc., Nux v., Puls., Robin., Triost.
Menstrual conditions [from] -- Bell., Cim., Dulc., Kali c., Mag. c., Puls., Ustil
Shellfish, roe [from] -- Camph.
Suppressed malaria [from] -- Elat.
Sweat [from] -- Apis.
Catarrh [with] -- Cepa, Dulc.
Intermittents [of] -- Ign., Nat. m.
Constipation, fever [with] -- Cop.
Croup [with], alternating -- Ars.
Diarrhœa [with] -- Apis, Bov., Puls.
Edema [with] -- Apis, Vespa.
Erosion [with], on toes -- Sul.
Itching [with], burning after scratching; no fever -- Dulc.
Liver disturbance [with] -- Astac.
Petechial disturbance, or erysipelatous eruption [with] -- Fragar.
Rheumatic lameness, palpitation, diarrhœa [with] -- Bov., Dulc.
Rheumatism [with], alternating -- Urt.
Sequelæ [with], from suppressed hives -- Apis, Urt.
Sudden coming and going [with] -- Antipyr.
Sudden, violent onset; syncope [with] -- Camph.
Climacteric [At] -- Morph., Ustil.
Menstrual period [At] -- Cim., Dulc., Kali c., Mag. c.
Night [At] -- Ant. c., Ars.
Bathing, walking in A. M. [from] -- Bov.
Cold [from] -- Ars., Dulc., Rhus t., Rumex, Sep.
Exertion, exercise [from] -- Apis, Calc. c., Hep., Nat. m., Psor., Sanic., Urt.
Fruit, pork, buckwheat [from] -- Puls.
Open air [from] -- Nit. ac., Sep.
Spirituous drinks [from] -- Chloral.
Warmth [from] -- Apis, Dulc., Kali c., Lyc., Sul.
Children [In] -- Cop.
Periodically, every year -- Urt.
Cold water [from] -- Apis, Dulc.
Hot drinks [from] -- Chloral.
Open air [from] -- Calc. c.
Warmth [from] -- Ars., Chloral, Sep.