Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2006:72:2;155-156
doi: 10.4103/0378-6323.25649
PMID: 16707829

Diagnosis of delayed pressure urticaria

KV Godse
 Consultant Dermatologist, Navi Mumbai, Maharashtra, India

Correspondence Address:
K V Godse
Shree Skin Centre, 22, L-market, Sector 8, Nerul, Navi Mumbai 400 706, Maharashtra
India
How to cite this article:
Godse K V. Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol 2006;72:155-156
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Delayed pressure urticaria (DPU) is a physical urticaria in which pressure is the physical stimulus that causes whealing. Pressure (defined as the force applied to a unit area of surface) induces reproducible whealing in DPU. Delayed cutaneous erythema and edema occur in association with marked subcutaneous swelling after the application of a sustained pressure stimulus to the skin. These signs occur as early as 30 min and typically 4 to 6 h later. Lesions may persist for up to 48 h. The response is dependent on the degree of pressure; duration of the stimulus; body site affected; and activity of the disease, which is variable in intensity.[1] Sites that previously have reacted to pressure have been found to be refractory to an additional pressure stimulus for at least 24 to 48 h. Most patients with DPU have chronic idiopathic urticaria (CIU) and angioedema. DPU should be considered in all patients with CIU whose disease is unresponsive to antihistamines. The disease is variable and remissions and exacerbations occur.

In DPU, a positive response after any form of pressure challenge consists of the appearance of palpable lesions after at least 30 min. Because most positive responses occur at 6 h, observers usually read pressure tests at 6 h. There is no standard method of pressure testing for DPU. Hence, I used simple and easily available implements like a 2 kg weight and a blood pressure cuff to test for DPU in 50 patients of CIU.

Fifty adult patients with chronic urticaria attending a private skin centre at Navi Mumbai were enrolled in this study. All antihistamines and oral steroids were stopped 48 h prior to the test. A 2 kg of weight, available at a general store, was placed on the right forearm of patients and a blood pressure cuff was strapped tightly around the weight to give sustained pressure [Figure - 1]. The pressure in the cuff is raised to 100 mm of Hg and is maintained for 1 min or till patient feels discomfort, whichever is earlier. Reading is taken after 30 min and at 6 h for visible and palpable swelling.

The 50 cases comprised of 33 male and 17 female patients (age range 18-80 years, mean age 43 years). Three patients (2 male and 1 female), out of the 50, tested positive with this instrument at 30 min and at 6 h. Positive test was seen as a palpable and visible swelling on right forearm at the site of pressure at the end of 30 min and at 6 h. These patients had typical history of swelling at the site of pressure, like waist and palms and soles.

In this test, we have tried to keep variables constant by using a standard 2 kg weight and a uniform pressure of 100 mm of Hg with the help of sphygmomanometer. Both the items can be easily procured. Patients should not be on antihistaminics or steroids for 48 h to prevent false negative test. In India, dermographometer is not available.

Ryan et al. tested for DPU by hanging a 15 lb weight at the end of a crepe bandage over the shoulder, thigh, or forearms of patients for at least 15 min.[2] Using this method, the area to which the force is applied is not defined; therefore, its reproducibility is not accurate enough for clinical trials, but the method is useful in clinical settings. Illig and Kunick designed an apparatus in which metal rods are held vertically in place, resting on a patient′s back, using a thick plastic sheet of material (PerspexÒ) to keep the rods in place. Adding more weights to the rods raised the pressure applied. The times of application of the pressure varied depending on the severity of the disease.[3] Modifications of this instrument have been used by other investigators studying DPU. Lawlor used a similar instrument with rods of 1.5 cm diameter and pressures of between 2.29 kg and 4.79 kg that were rested on the back for between 12 and 15 min.[4] Estes and Yung used a calibrated dermographometer to reproduce lesions in two patients. They applied pressures of 48, 73, 103, 136, 200 and 234 g/mm 2 for 10 s to the abdomen, arms and back and inspected the sites for up to 24 h. They showed a threshold whealing response of 136 g/mm 2 on the abdomen. By applying these pressures to the back for 5, 30, 60, 120 and 180 s respectively, they demonstrated that the time needed to produce a whealing response was inversely proportional to the degree of pressure applied.[5]

DPU is diagnosed infrequently, probably due to lack of interest in physical urticarias, unfamiliarity with the methods used to study the disease and the fact that chronic urticairia itself is frequently more severe in pressure-prone areas of the body (i.e., under belts or clothing). It is debatable as to whether this condition is mild DPU or is a pressure-induced worsening of chronic urticaria and angioedema.[1]

Summarizing, DPU is not uncommon in patients with chronic urticaria and this simple test is a valuable aid in a dermatologist′s office practice.

References
1.
Lawlor F, Black AK. Delayed pressure urticaria. Immunol Aller Clin North Am 2004;24:247-58.
[Google Scholar]
2.
Ryan TJ, Shim-Young N, Turk JL. Delayed pressure urticaria. Br J Dermatol 1968;50:485.
[Google Scholar]
3.
Illig L, Kunick J. Klinick and diagnostik der physikalischen urticaria. Der Hautarzt 1969;20:167. [PUBMED abstract]
[Google Scholar]
4.
Lawlor F, Barr R, Kobza BA, Cromwell O, Issacs J, Greaves M. Arachidonic acid transformation is not stimulated in delayed pressure urticaria. Br J Dermatol 1989;121:317.
[Google Scholar]
5.
Estes SA, Yung CW. Delayed pressure urticaria: An investigation of some parameters of lesions induction. J Am Acad Dermatol 1981;5:25.
[Google Scholar]

Fulltext Views
161

PDF downloads
51
Show Sections