The Correlation Between Weather and Urticaria Change

8/10/2019 The Correlation Between Weather and Urticaria Change

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CHAPTER I

I.I INTRODUCTION

Urticaria describes a heterogeneous group of diseases, whose cardinal symptoms are

itching wheals. With a high life time prevalence of 25%, this disease is of major relevance.

The most common type is spontaneous Urticaria in which the wheals seem to arise without

provocation. ts subtypes are acute and chronic. The mechanism of wheal formation is the

activation and degranulation of mast cells. !owever, the etiology of the wheals is

multifacted. n case of acute spontaneous urticaria, the underlying cause does not have to be

verified. t is treated symptomatically by its self"limiting course of disease. The chronic

spontaneous, less fre#uent form of urticaria is treated curatively by identification and

elimination of underlying causes, such as autoimmune processes, intolerance to food

additives and chronic infections. The chronic subtype can persist for years and thus has an

e$tensive socioeconomic impact. ncidence rates for acute urticaria are similar for men and

women, chronic urticaria occurs more fre#uently in women &'%(.Urticaria can occur in any

age group, although chronic urticaria is more common in the fourth and fifth decades. 4 Things

that trigger commonly trigger an allergic reaction, but there are other causes of urticaria, and

one of them is weather, solar e$posure and cold e$posure.5

The writer choose this topic because of urticaria is the most fre#uent dermatologic

disorder. The etiologies of urticaria are numerous, one of them is weather. )s we *now,

ndonesia is the tropical country that has dry and rain season. +ry season has hot weather,

and solar e$posure can induce urticaria solar urticaria(. ain season can be possible for

having cold weather that can induce cold urticaria.

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Urticaria appears as raised, well"circumscribed areas of erythema and edema

involving the dermis and epidermis that are very pruritic. -ecause of that, before we discuss

about urticaria and its correlation with weather, firstly we must *now about s*in anatomy,

especially dermis and epidermis. These all will be written in chapter and .

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CHAPTER II

II.I ANATOMY OF SKIN

The s*in covers the entire e$ternal surface of the human body and is the principal site of

interaction with the surrounding world. t serves as a protective barrier that prevents internal

tissues from e$posure to trauma, ultraviolet U( radiation, temperature e$tremes, to$ins, and

bacteria. /ther important functions include sensory perception, immunologic surveillance,

thermoregulation, and control of insensible fluid loss.

The integument consists of two mutually dependent layers, the epidermis and dermis, which

rest on a fatty subcutaneous layer, the panniculus adiposus. The epidermis is derived

primarily from surface ectoderm but is coloni0ed by pigment"containing melanocytes of

neural crest origin, antigen"processing 1angerhans cells of bone marrow origin, and pressure"

sensing er*el cells of neural crest origin. The dermis is derived primarily from mesoderm

and contains collagen, elastic fibers, blood vessels, sensory structures, and fibroblasts.6, 7

+uring the fourth wee* of embryologic development, the single cell thic* ectoderm and

underlying mesoderm begin to proliferate and differentiate. The speciali0ed structures formed

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by the s*in, including teeth, hair, hair follicles, fingernails, toenails, sebaceous glands, sweat

glands, apocrine glands, and mammary glands also begin to appear during this period in

development. Teeth, hair, and hair follicles are formed by the epidermis and dermis in

concert, while fingernails and toenails are formed by the epidermis alone. !air follicles,

sebaceous glands, sweat glands, apocrine glands, and mammary glands are considered

epidermal glands or epidermal appendages, because they develop as downgrowths or

diverticula of the epidermis into the dermis.6, 8

The definitive multi"layered s*in is present at birth, but s*in is a dynamic organ that

undergoes continuous changes throughout life as outer layers are shed and replaced by inner

layers. 3*in also varies in thic*ness among anatomic location, se$, and age of the individual.

This varying thic*ness primarily represents a difference in dermal thic*ness, as epidermal

thic*ness is rather constant throughout life and from one anatomic location to another. 3*in is

thic*est on the palms and soles of the feet 4.5 mm thic*(, while the thinnest s*in is found on

the eyelids and in the postauricular region '.'5 mm thic*(.

ale s*in is characteristically thic*er than female s*in in all anatomic locations. hildren

have relatively thin s*in, which progressively thic*ens until the fourth or fifth decade of life

when it begins to thin. This thinning is also primarily a dermal change, with loss of elastic

fibers, epithelial appendages, and ground substance.9

II.I.I EPIDERMIS

The epidermis contains no blood vessels and is entirely dependent on the underlying dermis

for nutrient delivery and waste disposal via diffusion through the dermoepidermal junction.

The epidermis is a stratified, s#uamous epithelium that consists primarily of *eratinocytes in

progressive stages of differentiation from deeper to more superficial layers. The named layers

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of the epidermis include the stratum germinativum, stratum spinosum, stratum granulosum,

and stratum corneum.

II.I.II DERMIS

The primary function of the dermis is to sustain and support the epidermis. The dermis is a

more comple$ structure and is composed of 2 layers, the more superficial papillary dermis

and the deeper reticular dermis. The papillary dermis is thinner, consisting of loose

connective tissue containing capillaries, elastic fibers, reticular fibers, and some collagen. The

reticular dermis consists of a thic*er layer of dense connective tissue containing larger blood

vessels, closely interlaced elastic fibers, and coarse bundles of collagen fibers arranged in

layers parallel to the surface.

The reticular layer also contains fibroblasts, mast cells, nerve endings, lymphatics, and

epidermal appendages. 3urrounding the components of the dermis is the gel"li*e ground

substance, composed of mucopolysaccharides primarily hyaluronic acid(, chondroitin

sulfates, and glycoproteins. The deep surface of the dermis is highly irregular and borders the

subcutaneous layer, the panniculus adiposus, which additionally cushions the s*in.

II.II URTICARIA

!ives are welts on the s*in that often itch. These welts can appear on any part of the s*in.

!ives vary in si0e from as small as a pen tip to as large as a dinner plate. They may connect

to form even larger welts.

) hive often goes away in 26 hours or less. 7ew hives may appear as old ones fade, so hives

may last for a few days or longer. ) bout of hives usually lasts less than & wee*s. These hives

are called acute hives. f hives last more than & wee*s, they are called chronic hives.

)cute hives often result from an allergy, but they can have many other causes.

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The medical term for hives is urticaria. When large welts occur deeper under the s*in, the

medical term is angioedema. This can occur with hives, and often causes the eyelids and lips

to swell. n severe cases, the throat and airway can swell, ma*ing breathing or swallowing

difficult. f this occurs, the person needs emergency care right away.

+octors put hives into two categories8

4. Acute h!e", when the condition lasts for less than & wee*s also called 9acute

urticaria9(.

2. Ch#$%c h!e",when the condition lasts for longer than & wee*s 9chronic urticaria9(.

II.II.I SI&NS AND SYMPTOMS

The raised red bumps that we call hives can appear anywhere on the body. !ere are some

signs to watch for8

!ives often itch or sting.

!ives can range in si0e from as small as a few millimeters across to as big as a dinner

plate.

ndividual hives may change shape or appear in clusters. 3ometimes hives join

together to form larger patches.

!ives can spread or show up on a different part of the body.

n a few rare cases, hives are part of a serious allergic reaction called anaphyla$is. :$posed to

temperature e$tremes, stress, infections, or illnesses. ;eople often have a trigger what causes

the hives(. :very time they are e$posed to that trigger, they get hives

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:$ercise

3tress

;ressure on the s*in, such as from sitting too long

ontact with chemicals

3cratching the s*in

!ives can happen within minutes of e$posure to the trigger. /r you can have a delayed

reaction of more than two hours.5

II.II.III PATHOPHYSIO'O&Y

Urticariaresults from the release of histamine, brady*inin, leu*otriene 6, prostaglandin +2,

and other vasoactive substances from mast cells and basophils in the dermis. These

substances cause e$travasation of fluid into the dermis, leading to the urticarial lesion. The

intense pruritus of urticaria is a result of histamine released into the dermis. !istamine is the

ligand for 2 membrane"bound receptors, the !4 and !2 receptors, which are present on many

cell types. The activation of the !4 histamine receptors on endothelial and smooth muscle

cells leads to increased capillary permeability. The activation of the !2 histamine receptors

leads to arteriolar and venule vasodilation.

This process is caused by several mechanisms. The type allergic g: response is initiated by

antigen"mediated g: immune comple$es that bind and cross"lin* =c receptors on the surface

of mast cells and basophils, thus causing degranulation with histamine release. The type

allergic response is mediated by cytoto$ic T cells, causing deposits of immunoglobulins,

complement, and fibrin around blood vessels. This leads to urticarial vasculitis. The type

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immune"comple$ disease is associated with systemic lupus erythematosus and other

autoimmune diseases that cause urticaria.(), ((

omplement"mediated urticarias include viral and bacterial infections, serum sic*ness, and

transfusion reactions. Urticarial transfusion reactions occur when allergenic substances in the

plasma of the donated blood product react with pree$isting g: antibodies in the recipient.

ertain drugs opioids, vecuronium, succinylcholine, vancomycin, and others( as well as

radiocontrast agents cause urticaria due to mast cell degranulation through a non > g:"

mediated mechanism. Urticaria from nonsteroidal anti"inflammatory drugs may be g:"

mediated or due to mast cell degranulation, and there may be significant cross"reactivity

among the nonsteroidal anti"inflammatory drugs 73)+s( in causing urticaria and

anaphyla$is.()

The physical urticarias in which some physical stimulus causes urticaria include immediate

pressure urticaria, delayed pressure urticaria, cold urticaria, and cholinergic urticaria.(( =or

some urticarias, especially chronic urticarias, no cause can be found, despite e$haustive

efforts>the so"called idiopathic urticarias, although most of these are chronic autoimmune

urticaria as defined by a positive autologous serum s*in test )33T(.(* This test is not specific

for autoantibodies against a specific antigen or diagnostic of a specific disease state.(+ To

date, no reliable test e$ists to identify with certainty if chronic urticaria is autoimmune or

nonautoimmune in the specific patient.(4

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http://emedicine.medscape.com/article/809378-overviewhttp://emedicine.medscape.com/article/756444-overviewhttp://emedicine.medscape.com/article/780074-overviewhttp://emedicine.medscape.com/article/1050387-overviewhttp://emedicine.medscape.com/article/1050387-overviewhttp://emedicine.medscape.com/article/1049978-overviewhttp://emedicine.medscape.com/article/1050052-overviewhttp://emedicine.medscape.com/article/809378-overviewhttp://emedicine.medscape.com/article/756444-overviewhttp://emedicine.medscape.com/article/780074-overviewhttp://emedicine.medscape.com/article/1050387-overviewhttp://emedicine.medscape.com/article/1050387-overviewhttp://emedicine.medscape.com/article/1049978-overviewhttp://emedicine.medscape.com/article/1050052-overview


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II.II.I EPIDEMIO'O&Y

FRE-UENCY

U%te St/te"

)cute urticaria affects 45"2'% of the general population at some time during their lifetime.

I%te#%/t$%/0

The fre#uency of urticaria internationally is similar to that in the United 3tates.

MORTA'ITY1MOR2IDITY

;ruritus itching( and rash are the primary manifestations of urticaria, and permanent

hyperpigmentation or hypopigmentation are rare. )cute urticariais usually self"limited and

commonly resolves within 26 hours but may last up to & wee*s. hronic urticarialasts more

than & wee*s. 7either acute nor chronic urticaria results in long"term conse#uences other than

an$iety and depression. The depression can be severe enough to lead to suicide in rare cases.

)lso, many of the diseases associated with chronic urticaria may cause very significant

morbidity and mortality.

SE3

ncidence rates for acute urticaria are similar for men and women, chronic urticaria occurs

more fre#uently in women &'%(.

A&E

Urticaria can occur in any age group, although chronic urticaria is more common in the fourth

and fifth decades.

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CHAPTER III

III. DISCUSSION

III.I SO'AR URTICARIA

3un allergy is a condition in which sunlight triggers a s*in reaction. =or most people, sun

allergy symptoms include an itchy red rash in areas that have been e$posed to sunlight. )

severe sun allergy may cause hives, blisters or other symptoms. There are several types of sun

allergy > including polymorphic light eruption ;1:(, actinic prurigo, chronic actinic

dermatitis )+( and solar urticaria.

3olar urticaria is a form of chronic hives that is caused by e$posure to sunlight. ;eople with

this condition e$perience itching, redness and hives on areas of s*in e$posed to sunlight. )t

times, symptoms can be confused with a sunburn, although solar urticaria can occur within

minutes of e$posure to the sun, and goes away much #uic*er less than a day( after sun

e$posure has stopped.

The appearance of the hives is no different from other forms of urticaria, although these hives

only occur on s*in that is directly e$posed to the sun. !ives may also occur under thin

clothing. 3*in that is fre#uently e$posed to sunlight, such as the s*in on the face, is typically

un*li*ely to develop hives as opposed to s*in that is less fre#uently e$posed to the sun.

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t appears that people with solar urticaria ma*e allergic antibodiesagainst various proteins

found in their own s*in. These proteins? structure changes with sunlight, allowing the allergic

reaction to occur, causing hives. t is possible for a person with solar urticaria to e$perience

anaphyla$is is enough s*in is e$posed to sunlight.

III.I.I SYMPTOMS

3un allergy symptoms depend on the particular type of sun allergy you have. 3olar urticaria

symptoms start within minutes of e$posure to sunlight and can include hives, itching and

blisters. 3olar urticaria can affect both e$posed areas and areas covered by clothes. t occurs

most often in older adults. 3ymptoms usually improve within an hour after covering e$posed

s*in.

III.I.II CAUSES

3olar urticaria is possibly caused by an antigen"antibody reaction. 3olar irradiation may

induce an antigen in the serum or plasma of affected individuals. ntradermal injection of

serum from a solar urticaria patient passively, but not consistently, transfers the condition to a

healthy individual.

The following types of solar urticaria have been proposed8

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Type " This type is characteri0ed by an immunoglobulin : g:(@mediated

hypersensitivity to specific photoallergens generated only in solar urticaria patients

Type " This type is characteri0ed by an g:"mediated hypersensitivity to

nonspecific photoallergens found in solar urticaria patients and in healthy individuals

;assive"transfer test findings are positive in patients with type solar urticaria, but they may

be positive or negative in those with type .

The wide action spectrum 2A'"B'' nm( implicated for solar urticaria may be related to the

specific photoallergen and its molecular weight. +iversity in the reported action spectra for

the disease may be due to differences in photoallergens. n addition, spectra believed to be

responsible for either inhibition or augmentation of the reaction have been detected. (5

omple$ interactions occur between the various wavelengths and the photoallergen.

The result of these interactions is mast cell degranulation with subse#uent histamine release.

ediators other than histamines may also be involved.

nhibition of solar urticaria with light suppresses the wheal"flare response following

intradermal injection of photoactivated autologous serum but does not suppress the wheal and

flare associated with compound 6BCB'.(6

III.I.III TESTS AND DIA&NOSIS


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help identify what?s going on. f this is the case, you?ll most li*ely need to see a

dermatologist.

Tests to diagnose s*in reactions caused by sun e$posure can include8

U light testing. )lso called phototesting, this e$am is used to see how your s*in

reacts to different wavelengths of ultraviolet light from a special type of lamp.

+etermining which particular *ind of U light causes a reaction can help pinpoint

which sun allergy you have.

;hotopatch testing. This type of test is used if your doctor suspects something you?ve

come in contact with ma*es your s*in react to sunlight. To do the test, your doctor

will apply two identical patches of a substance that may be causing a reaction to your

s*in. )fter 26 hours, your doctor will e$pose one area to U light, but not the other. f

a reaction occurs only on the e$posed area, it?s li*ely your reaction is lin*ed to the

substance in #uestion. 1ight testing and photopatch testing are generally available

only at speciali0ed clinics.

-lood tests and s*in samples. These tests usually aren?t needed. !owever, your doctor

may order one of these tests if he or she suspects your symptoms might be caused by

an underlying condition such as lupus instead of a sun allergy. With these tests, a

blood sample or a s*in sample biopsy( is ta*en for further e$amination in a

laboratory.(7, (8

III.I.I TREATMENTS AND DRU&S

Treatment depends on the particular type of sun allergy you have. t may include8

orticosteroid creams. These creams are available over"the"counter and in stronger,

prescription form. =or e$ample, hydrocortisone medications ortaid, others( are

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available over"the"counter and triamcinolone medications Denalog, others( re#uire a

prescription.

/ral antihistamines. These medications bloc* histamines, symptom"causing

chemicals released during an allergic reaction. generally used to treat infections > are used for chronic actinic

dermatitis.

Ultraviolet light therapy. This treatment is also called phototherapy. ) special lamp is

used to shine ultraviolet light on areas of your body that are often e$posed to the sun.

t?s generally done a few times a wee* over a period of several wee*s each spring.

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+uring the course of treatments, your doctor will gradually increase the dose of U

radiation.


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with the cold. )s much as possible, people with cold urticaria should avoid e$posure to cold

air and cold water. =or e$ample, swimming in cold water is the most common cause of a

severe, whole"body reaction > leading to fainting, shoc* and even death.

f you thin* you have cold urticaria, also called cold allergy or cold hives, consult your

doctor. Treatment for cold urticaria may include antihistamines ta*en before cold e$posure.

III.II.I SYMPTOMS

old urticaria symptoms begin soon after the s*in is e$posed to a sudden drop in air

temperature or to cold water. )lthough symptoms may begin during the cold e$posure,

symptoms of cold urticaria are often worse during rewarming of the e$posed s*in. The

majority of cold urticaria reactions occur when s*in is e$posed to temperatures lower

than 6' = 6.6 (, but some people can have reactions to warmer temperatures. +amp

and windy conditions may ma*e cold urticaria more li*ely.

old urticaria signs and symptoms may include8

eddish, itchy hives wheals( on the area of s*in that was e$posed to cold. Wheals

generally last for about half an hour.

3welling of hands when holding cold objects.

3welling of lips when eating cold foods.

n rare cases, severe swelling of the tongue and throat that can bloc* breathing

pharyngeal edema(.

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III.II.II CAUSES

The cause of cold urticaria isn?t clear. ertain people appear to have overly sensitive s*in

cells, either due to an inherited trait or caused by a virus or other illness. :$posure to cold

triggers the release of histamine and other immune system chemicals into the s*in. These

chemicals cause redness, itching and other symptoms.

III.II.III RISK FACTORS

old urticaria can occur in any age group, whether female or male.


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old urticaria can be diagnosed by placing an ice cube on e$posed s*in for several minutes.

f you have cold urticaria, a raised, red bump hive( will form after the ice cube is removed.

ost cases of urticaria occur in children and young adults and don?t have an apparent

underlying cause. This type of urticaria usually gets better on its own after a few wee*s to

months, but sometimes it can last for years.

n some cases, cold urticaria is caused by an underlying condition that affects the immune

system. 3ome conditions that can cause cold urticaria include hepatitis, rheumatoid arthritis,

certain cancers or an infection such as mononucleosis. f your doctor suspects you have an

underlying condition, you may need blood tests or other tests.*)

III.II. TREATMENTS AND DRU&S

There is no cure for cold urticaria, but treatment can help. Treatment includes avoiding cold

temperatures and e$posure to sudden changes in temperature. edications can help prevent

and reduce symptoms.

edications used to treat cold urticaria include8

)ntihistamines. These medications bloc* the symptom"producing release of

histamine. 3ome of these medications are available over"the"counter, whereas others

re#uire a prescription. :$amples include loratadine laritin(, fe$ofenadine )llegra(,

cetiri0ine Eyrtec(, levocetiri0ine Fy0al( and desloratadine larine$(.

yproheptadine. This medication is an antihistamine that also affects nerve impulses

that lead to symptoms.

+o$epin 3ilenor(. 7ormally used to treat an$iety and depression, this medication can

also reduce cold urticaria symptoms.

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These medications won?t cure cold urticaria > they?ll only ease symptoms. f you have cold

urticaria because of an underlying health problem, you may need medications or other

treatment for that condition as well.

III.II.I PREENTION

There?s no way to avoid getting cold urticaria in the first place, but you can help prevent

symptoms by ta*ing medications as prescribed and avoiding cold temperatures, especially

cold e$posure to unprotected s*in.*(, **

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CHAPTER I

I.I CONC'USION

Urticaria, commonly referred to as hives, is the most fre#uent dermatologic disorder.

t appears as raised, well"circumscribed areas of erythema and edema involving the dermis

and epidermis that are very pruritic. Urticaria may be acute lasting less than & wee*s( or

chronic lasting more than & wee*s(. The etiologies of urticaria are numerous, one of them is

weather. )s we *now, ndonesia is the tropical country that has dry and rain season. +ry

season has hot weather, and solar e$posure can induce urticaria solar urticaria(. ain season

can be possible for having cold weather that can induce cold urticaria.

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6. +aut , 3taubach ;, !Lrmann D, Dlime* 1, ;faar /. !7/"UniversitMts*lini*,

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&. arlson -. ntegumentary, s*eletal, and muscular systems. n8Human Embryology

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The Correlation Between Weather and Urticaria Change

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