Urticaria

“ Sometimes it takes the form of urticaria factitia, in which the skin reacts to every kind of mechanical stimulation, such as rubbing, scratching, or pressure, all of which alike lead to the formation of weals, which may be diffused all over the body. Less often in association with disturbances of menstruation, acute œdema or erythema are observed. ”

“ Describe urticaria papulosa.
Urticaria papulosa (formerly called lichen urticatus) is a variety in [Pg 54] which the lesions are small and papular, developing usually out of the ordinary wheals. They appear as a rule suddenly, rarely in great numbers, are scattered, and after a few hours or, more commonly, days gradually disappear. The itching is intense, and in consequence their apices are excoriated. Sometimes the papules are capped with a small vesicle (vesicular urticaria) . It is seen more particularly in ill-cared for and badly-nourished young children. ”

“ The absence of itching in nearly all the cases of Urticaria factitia, while the patches are level with the normal skin, and their unchanging character, are all strongly against such a diagnosis, to say nothing of the extreme rarity of adult Urticaria pigmentosa and the improbability of one man meeting with nine cases of it. ”

“ In this matter he is confirmed by J. Thomson, who noted that these children not infrequently give a history of having had asthma, urticaria, eczema, stammering, and other nervous complaints, also that in many instances uric acid crystals or a copious deposit of urates have been noted in their urine.
As to the “nervous” type, they labour with insomnia, night terrors, convulsions, and when older with migraine. To these liabilities must be added undue proneness to acne, seborrhœa, psoriasis, chilblains, angio-neurotic œdema, urticaria, etc., not to mention muscular and joint aches and pains. ”

“ The pathology of the lesions in this disease is as follows: reacting to some irritant, the blood-vessels dilate, serum is poured out from them into the tissues around, and compressing the vessels from without empties them of blood. This explains the white centre of the urticarial weal, the red margin of which is the clinical expression of the dilated and uncompressed vessels at the border. In those diseases grouped together under the name of erythema, although the majority of authors place them under the heading of inflammation, there is a good deal suggestive of a close relation to urticaria. ”

“ Burning, tingling, stinging, and itching are prominent subjective symptoms. The individual lesions are fugacious, inclining to disappear at one part and to show themselves at another. They are more apt to appear on parts subjected to pressure by contact of clothes, although no region is exempt. No age is spared, but the disease, especially in its acute form, is more common in the young. Ordinarily, urticaria is an acute disorder, lasting a few hours to several days, in which time frequent exacerbations may take place. ”

“ At times the wheals are peculiar as to formation or are complicated with another condition, and hence arise the so-called varieties of the disease. The most common of these is urticaria papulosa, which was formerly known as lichen urticatus. The lesions have the form of a papule with most of the characteristics of a wheal. ”

“ If fever supervenes, urticaria sometimes complicates these attacks.
In young children the inflammation is apt to involve a general catarrh of the whole intestinal track. Thirst is excessive, followed by vomiting and diarrhoea. The discharges are liquid, watery, offensive, acid, and out of all proportion to the amount of fluid absorbed by the stomach. The pulse becomes weak and fluttering, the skin pale, the features pinched, the eyes sunken, and the extremities cold. The tendency is toward rapid collapse and fatal issue. The symptoms describe what is usually known as cholera infantum. ”

“ It is probable that the pemphigus and urticaria, as well as this disease, have formerly been diseases of more danger; which the habit of innumerable generations may have rendered mild, and will in process of time annihilate. ”

“ They belong to the exanthematous class, and comprise roseola, erythema, urticaria, and rarely vesicular eruptions.37 But, instead of them, there may occur destructive tissue-lesions in the form of abscesses or ulcers. These affections are more usual on the limbs than on the trunk or face, but some of them may appear even in the mouth or fauces. Profuse sweats have been noticed elsewhere, and the important fact that they carry off large quantities of urea, which they deposit upon the skin. ”

“ Urticaria also is often of symmetrical development, is rarely accompanied by fever, and is characterized by typical wheals, which, however closely packed together, never have the smoothness of the surface affected with erysipelas.
PROGNOSIS.—The prognosis of a simple case of uncomplicated erysipelas occurring in an individual in fair health and possessed of a reasonable degree of vigor may be regarded as favorable. Even in the weakness of infancy a large area may be involved in the disease and a high degree of fever be aroused without alarming results. ”

“ The skin, partly for this reason, and partly because it shares in the general disturbance of nutrition, becomes dry, harsh, and scaly; after a time the face, and especially the nose and neighboring parts, assumes in many instances a violaceous hue, the minute superficial cutaneous veins are enlarged, and acne is common. The resulting appearance is almost characteristic of the habits of the individual. Alcoholic subjects frequently suffer from pruritis, urticaria, and eczema. ”

“ Describe the erythematous type of dermatitis herpetiformis.
The character of the eruption in the erythematous type resembles closely that of erythema multiforme and of urticaria, especially the former. The efflorescences usually make their appearance in crops, and are more or less persistent; fading sooner or later, however, and giving place to new outbreaks. Vesicles are often intermingled, developing from erythematous and erythemato-papular lesions or arising from apparently normal skin. ”

“ A number of medicinal substances, such as copaiba, cubebs, turpentine, valerian, chloral, salicylic acid, iodide of potassium, quinine, and others, taken internally, may provoke an attack. Malaria, functional and organic diseases of the uterus, a weak or irritable state of the nervous system, and impaired digestion are common causes of both the acute and chronic forms of the disease. Various nervous, hemorrhagic, and rheumatic diseases are also sometimes associated with urticaria. ”

“ An artificial idiosyncrasy seems to be developed.
[193]
Single doses, or the use of moderate doses for a short time, has been found to produce erythema, eczema, papular, pustular, or macular eruptions; also urticaria and herpes zoster. In a few well-authenticated instances, eruptions, exactly resembling and in some cases mistaken for those of measles and scarlatina, have been produced. They passed through regular gradations, finishing with the typical desquamation of the disease simulated. Further use of the chloral again produced the same disturbances. ”

“ If the anaphylaxis to the diphtheria antitoxin, horse serum, can develop arthritis, is it not probable that the most striking feature of gout, the inflammation of the joint, is also an anaphylaxis to poisons yet unknown to us but the same poisons that make the gouty urticaria and asthma? ”

“ The face is congested and swollen. The eyes are injected and present a bleared appearance, but the watery or weeping condition seen in measles is usually absent. The nose is dry, and a sore throat is not uncommon. Epistaxis is frequent.
A very important symptom which sometimes occurs in this stage is a cutaneous efflorescence, which may resemble urticaria, scarlet fever, or measles. ”

“ The dangers are suppuration in the sac and peritonitis; but the former, although sometimes accompanied by severe constitutional symptoms, is not likely to endanger life, and even formidable disturbances due to the latter are usually recovered from. The facts show that puncture very rarely indeed causes dangerous, especially fatal, symptoms. An eruption of urticaria has been observed to follow puncture with the trocar, and also aspiration, in a considerable proportion of the cases, but it has no special significance. ”

“ Such children walk late, talk late, learn late to feed themselves, to bite, and to chew effectively. Watery and fat, they carry with them into later childhood the infantile susceptibility to catarrhal infections of the lung, bowel, skin, etc., and they are apt to suffer, in consequence, from a succession of pyrexial attacks. Nasal catarrh, bronchitis, otitis media, enteritis, eczema, urticaria papulata, are apt to follow each other in turn, giving rise in many cases to a persistent enlargement Page 147 of the corresponding lymphatic glands. ”

“ The original diphtheria serum employed was not concentrated; so when a sufficient amount of antitoxic units to neutralize the toxins of the disease under treatment was employed, a large quantity of serum had to be injected. Experience shows that the injection of any foreign blood serum into an animal is followed by a certain amount of haemolysis, or blood destruction, and by {347} certain cutaneous manifestations, such as urticaria, erythemata, the familiar hives-like eruption and red itchy spots, which prove a great source of annoyance. ”

“ The diagnosis is not always easy, as urticaria arising in other ways frequently leads to similar vigorous scratching and formation of crusts of dried blood. Men who have some experience in this matter (for example, commercial travellers) , when they are attacked by severe itching at night, are in the habit of striking a light and searching in their bed and body-linen for the bugs, in order to be able to hand over the corpora delicti to the landlord if need be. ”

“ In the acute disease, where, as in the majority of cases, gastric disturbance is the exciting factor, a purgative—preferably a saline—should be given. In severe cases, if food is still in the stomach, an emetic will be of service, sulphate of zinc, ipecacuanha, and mustard being the best. The diet should be of the simplest kind. Aperients are generally indicated until recovery takes place. In chronic urticaria, where faulty digestion is the exciting cause, remedies appropriate to that condition are to be prescribed. In all cases attention is to be directed to the state of the general health. ”

“ Nettle rash or urticaria, so called from the appearance and tingling sensations resembling those caused by the sting of nettles, in some people, is very apt to follow the use of indigestible and unwholesome food. ”

“ As a local application, the inflamed surface may be covered with cloths wet in the mucilage of slippery elm. A preparation of equal parts of sweet oil and spirits of turpentine, mixed and painted over the surface, is an application of great efficacy.
For urticaria, the "Pleasant Pellets" should be administered in sufficient doses to move the bowels, the skin bathed with warm water rendered alkaline by the addition of common baking soda or saleratus, and, if there be any febrile symptoms, a little tincture of aconite or veratrum may be administered in one drop doses once each hour. ”

“ In the chapter on Neurotic Intestinal Affections attention is called to the fact that many patients who suffer from intestinal idiosyncrasies and have excessive reactions to special kinds of food, as cheese, strawberries, or the like, sometimes also suffer from skin lesions and intestinal disturbance through worry or excitement. While preparing for examinations or undergoing some physical trial or suffering from worry or anxiety such persons may have urticaria or even wheals on the skin. ”

“ Because scarlatina is a fever attended with a peculiar eruption on the skin; because rubeola is a fever attended with an eruption on the skin also peculiar; because variola is a fever attended with another peculiar eruption, and urticaria with another, these diseases are not made varieties of fever, but, designated by the term exanthemata, are formed into a separate order: while, on the other hand, fevers attended with petechiæ, with papulæ, with aphthæ, with vesicles, are accounted fevers, and accordingly are termed petechial, miliary, aphthous, erysipelatous, vesicular fevers ”

“ The Trombidiidæ, or Harvest Mites
In many parts of this country it is impossible for a visitor to go into the fields and, particularly, into berry patches and among tall weeds and grass in the summer or early fall without being affected by an intolerable itching, which is followed, later, by a breaking out of wheals, or papules, surrounded by a bright red or violaceous aureola, (fig. 43) . It is often regarded as a urticaria or eczema, produced by change of climate, an error in diet, or some condition of general health. ”

“ One thinks of the gouty patient who cannot take iron or digitalis because it aggravates the gouty pain and of the attack of gout that is brought on by a glass of champagne or a piece of beef or a few strawberries that the majority of mankind can take freely without harm. Now, if urticaria, eczema, arthritis, asthma and hay fever form a picture of anaphylaxis, and if these symptoms also form the picture of the gouty diathesis, is it not probable that one of these pictures can be explained in the terms of the other? ”