Urticaria Pigmentosa: Causes, Symptoms, Diagnosis & Treatment

Urticaria Pigmentosa is also known as Maculopapular Mastocytosis. It is the most common form of skin affection which is seen in both adults and children.

90% of the affections are seen in children within the first two years of life. In adults, it is more of a chronic form with systemic involvement. Usually, there is no gender preference, and it can occur in all races.

The lesions are prominent on the trunk and occur on the scalp, face, and extremities.

Mastocytosis can occur in your skin, bones, intestines, or other organs. Most of the children outgrow Urticaria as they grow.

In some cases of mastocytosis, it can progress to a severe form of cancer called mast cell leukemia and mast cell sarcoma.

In such cases, the organ loses its function due to mast cell infiltration. This happens in organs like bone marrow, bones, guts, or the liver. These are very rare and aggressive forms.

Pathophysiology of Urticaria Pigmentosa

Urticaria Pigmentosa occurs due to abnormal collections of mast cells in the skin. But they are normally present in the skin.

These mast cells contain granules consisting of histamine and other chemicals. When the mast cells are disturbed, these chemicals are released into the surrounding skin.

These chemicals make the blood vessels leaky, leading to itching, swelling, and redness.

Types of Urticaria

First- it involves three or fewer lesions called mastocytomas.

Second – 4-100 lesions, and this is called urticaria Pigmentosa.

Third – it involves diffuse cutaneous involvement.

Urticaria is classified based on duration:

Acute: – wheals that have occurred for less than six weeks.

Chronic: -recurrent Urticaria occurring twice a week for at least six weeks.

Individual lesions last for 4 to 36 hours.

Causes of Urticaria Pigmentosa

The exact cause is unknown, but research suggests that genetic change in a protein called c-kit on the surface of the mast cells may result in abnormal proliferation of mast cells.

Other factors which trigger the symptoms of Urticaria are:

• Emotional stress

• Certain foods

• Exercise

• Heat

• Insects and snake stings

• Bacterial toxins

• Local trauma to skin lesion

• Alcohol

• Narcotics

• Eye drops containing dextran

• Drugs like aspirin, NSAIDs, POLYMYXIN B, etc.

Symptoms of Urticaria Pigmentosa

These are the symptoms most commonly observed in both children and adults.

• Dark-colored lesion on the skin. The lesion is brownish in appearance.

• When the lesions are rubbed, it releases histamine, which leads to intense itching along with blisters or hives. This is called DARIER’S SIGN.

• Severe itching of the skin

• Pink or red swollen patches on the skin.

• Hives may appear alone, in the group, or on a large area of the body.

• Flushing (redness of the skin)

• Hyperpigmentation of lesions (the lesions become dark in appearance)

• A fluid-filled blister forms on being scratched in small children.

Complications of Urticaria Pigmentosa

These symptoms are mostly seen in adults or adolescents. These are less frequently seen in children.

• Headache

• Flushing of skin (heat and redness)

• Diarrhea

• Vomiting

• Wheezing (it’s a whistling sound heard in the chest during expiration)

• Increased heart rate

• Decreased blood pressure

• Sometimes it can affect bigger organs like the spleen, liver, bone marrow, etc.

• People with mastocytosis sometimes develop life-threatening anaphylactic shock.

• Osteoporosis in which bones become weak and soft.

• Cytopenia, where the body is not able to make as many cells it should.

• Cancer but is very rare.

Diagnosis of Urticaria Pigmentosa

The physician will be able to diagnose Urticaria on observation of the lesion itself. Then he might ask you to avoid the triggering factors, and then if he suspects an allergy, he might ask for an allergy test.

Other investigations

• Skin biopsy: – it will help to know the no of mast cells.

• Urine test: – to detect histamine levels

• Blood test: – to know the blood cell count and tryptase levels. Tryptase is an enzyme that is found in mast cells.

Management of Urticaria Pigmentosa

Since there is no cure to urticaria Pigmentosa, if triggering factors are avoided, it will help in reducing the severity of the symptoms.

1. TRIGGERING FACTORS

• Exercise, heat, and friction aggravate the condition. Hence it is better to avoid these.

• Certain medications lead to degranulation of mast cells like aspirin, codeine, and morphine, alcohol, cough medicines containing alcohol or codeine. Hence it’s better to avoid these when suffering from Urticaria.

• Thiamine (vitamin), quinine is also known to trigger Urticaria.

• Dyes that are used to take an x-ray

• Certain anesthetic drugs.

It is best to avoid all these triggering factors.

2. Try and avoid rubbing the skin.

3. Picking the blisters should also not be done.

4. And do not scratch the lesions as this will lead to more histamine release, thereby aggravating the symptoms.

5. In children, it’s always best to avoid a hot water bath as it leads to drying of the skin and makes the itching worse.

6. One must use light cotton fabrics.

Conventional line of treatment

There is no cure for urticaria Pigmentosa. Hence the aim is to decreases the severity of symptoms.

Antihistamines are given for itching and flushing of the skin.

Corticosteroids act as an anti-inflammatory.

Hydrocolloid dressing, fluocinolone, chlorpheniramine maleate all these drugs are used to ease the symptoms.

In adults, photochemotherapy using UV rays is also used effectively.

Prolonged use of steroids leads to insulin resistance, glucose intolerance, and red skin syndrome.

Homeopathic Medicines For Urticaria Pigmentosa

As we are aware, the conventional line of treatment doesn’t offer a cure for urticaria Pigmentosa. It offers only symptomatic relief, and prolonged use of those drugs creates its side effects.

But timely intervention with homeopathy will help decrease the severity and intensity of the disease and bring about the cure.

Duration of treatment would vary from person to person, depending upon the intensity of their suffering.

1.ANTIMONIUM CRUDUM: For Urticaria with gastric derangement

Symptoms:

It is indicated in individuals who are extremely irritable and fretful. They present with a thickly coated white tongue. They tend to grow fat.

All their complaints are aggravated by heat and cold bathing.

The patient cannot bear the heat of the sun.

Urticarial eruptions appear like measles. They itch when the patient becomes warm in bed.

Their skin is extremely dry.

And all these complaints are associated with gastric derangements.

Dosage and potency:

30C, 200C potency can be administered. one must not do repetition frequently since it’s a deep-acting remedy.

2.ANTIPYRINUM: For Urticaria with internal coldness

Symptoms:

Antipyrinum acts on the vasomotor center, responsible for dilatation of capillaries of the skin leading to hyperemia and swelling.

The patient experiences erythema with intense pruritus.

Urticaria appears and disappears suddenly with internal coldness.

It is also indicated in severe cases like angioneurotic oedema, which is a life-threatening condition.

Dark scars on the skin of the penis with oedema occur in certain patients.

Swelling of lips and tongue is also seen in certain cases. The face becomes red and swollen and appears puffy.

Dosage and potency:

one can administer 30C and 200C potency to the patient. Repetition would depend on the state of the patient.

3.ASTACUS FLUVIATILIS: For Urticaria with liver complaints

Symptoms:

It is capable of curing Urticaria with liver complaints. Nettle rash with itching is seen all over the body.

The patient in various parts experiences stinging pain. Erysipelas eruptions with nettle rash appear in the body.

The patient in the liver region experiences cramps. The complaints are aggravated by air and uncovering.

When the rashes increase, it gives rise to violent fever and headache.

Dosage and potency:

30C potency can be administered. Repetition will depend upon the state of the patient.

4.CHLORALUM HYDRATUM: For Urticaria with palpitations

Symptoms:

Red blotches like measles appear on the skin.

Alcoholic drinks aggravate erythema in the skin. It is associated with palpitation and pain in tendons and extensors.

Intense itching of the skin is marked. Skin feels like a cold stone.

Wheals are brought on by chill and get better by warmth.

Urticarial rashes are aggravated by alcohol and hot drinks.

And the complaints are aggravated after eating and at night.

Dosage and potency:

30C potency with frequent repetition will bring about the desired results in the case of Urticaria.

5.COPAIVA OFFICINALIS: For Urticaria with fever and constipation

Symptoms:

A well-marked nettle rash is an indication of the medicine. Urticaria is always associated with fever and constipation.

Flushing with lesions is seen, especially around the abdomen.

Circumscribed lenticular patches are seen with a mottled appearance.

The patches itch a lot. Copaiva is a very good remedy for chronic Urticaria in children.

Bullous eruptions are very common in children.

Dosage and potency:

30C, 200C potency 3-4 pills twice or thrice per day till improvement.

6.FRAGARA VESCA: For Urticaria with a strawberry tongue

Symptoms:

This medicine is capable of curing urticarial rashes in susceptible individuals. It is also called strawberry anaphylaxis.

Urticarial eruptions are seen all over the body, and also, the whole body is swollen.

This affects the tongue as well, leading to swelling, and it appears like a strawberry. Hence tongue is called as Strawberry tongue.

Dosage and potency:

In severe cases like anaphylaxis, always give in high potency.

7.NATRUM PHOS: For Urticaria resulting from acidity and excess of lactic acid

Symptoms:

Whenever the patient consumes too much sugar, it breaks down, and there is excess lactic acid in the body. This lactic acid is responsible for various complaints of the patient.

The patient’s complaints arise dues to excessive acidity. The complaints are also brought on due to mental stress or sexual vices.

The patient develops severe itching in various parts of the body, especially the ankles.

Hives are smooth red and shiny. The patient’s feet are icy cold during the daytime and burn at night.

Dosage and potency:

30C and 200C potency can be used. Repetition needs to be done as per the state of the patient.

8.PULSATILLA: For Urticaria after rich fatty food

Symptoms:

It is suited to individuals who are mild, timid, gentle, and of a yielding disposition. They can cry readily.

Their symptoms rise to a certain pitch and cease suddenly. Their symptoms are ever-changing.

Symptoms appear on one side or go to side lain on. The patient is thirstless and chilly, but they crave open air.

The patients are sensitive to woolen clothing as they develop itching and eruption.

These patients develop Urticaria after eating rich and fatty food and are accompanied by diarrhea.

Even delayed menses can bring about Urticaria in these patients. Urticaria worsens on being undressed in these patients.

The lesions itch a lot if they get heated.

Dosage and potency:

30C, 200C potency in a single dose. Repeat the dosage after the action of the previous dose has been exhausted.

READ MORE ABOUT PULSATILLA

9.URTICA URENS: For Chronic Urticaria

Symptoms:

This medicine is excellent for those when they get Urticaria at the same time every year. It antidotes the bad effects of shellfish.

It is also indicated when the patient suffers from rheumatism and Urticaria alternately.

The developed blotches are very itchy. Urticaria presents with burning and formication.

It’s the best remedy for the suppressed nettle rash.

It gets indicated in urticaria nodosa and also in life-threatening complications like angioneurotic oedema.

When the patients develop fever, they feel general heat with soreness over the abdomen.

The patients’ complaints worsen from snow-air, water, cool, moist air, touch, and even lying on the arm.

The patients develop vomiting if Urticaria is suppressed. Pinworms usually accompany the complaints of hives.

Dosage and potency:

Mother tincture ten drops in half glass water twice or thrice a day, depending upon the intensity of symptoms, can be prescribed.

When there is intense burning and itching, one can apply mother tincture locally.

10.VESPA CRABRO: For Urticaria with burning, stinging, and soreness

Symptoms:

The skin of the patient is red with intense itching and burning.

Wheals, macules are formed with swelling. Burning, stinging, and soreness are present at the site.

The complaints of the patient are relieved when they bathe with vinegar.

Dosage and potency:

30C potency 3-4 pills thrice a day till improvement.

11.RHUSTOX: For Urticaria from getting wet

Symptoms:

The patients requiring this medicine develop Urticaria after becoming wet in the rain.

The wheels are red and swollen with intense itching. The wheals burn tremendously.

The skin of the patient is very sensitive to cold air. The eruptions become worse in the genitals.

Skin complaints alternate with dysentery. So, Rhus tox, when administered, corrects the imbalance in the two systems, i.e., skin and gastric system.

Dosage and potency:

200C, 1M, and higher potency can be administered as per the state of the patient.

READ MORE ABOUT RHUS TOX

12.SULPHUR: For Urticaria with itching and burning

Symptoms:

The patient is prone to skin affection after the application of local ointments.

The wheels itch and burn extremely. The complaints are aggravated by washing and scratching.

Itching worsens from warmth, at night, in the evening. Urticaria recurs every year in springtime and damp weather.

Urticaria alternates with asthma.

Dosage and potency:

in chronic conditions, 200C and higher potencies work well and do not repeat it too frequently.

13.ICHTHYOLUM: For Chronic Urticaria

Symptoms:

The patient is extremely irritable and depressed. They are forgetful and lack concentration.

The patient is prone to chronic hives. The wheels are red, inflamed, and painful.

The hives are extremely itchy and are accompanied by heat and irritation.

Dosage and potency:

30C potency with frequent repetition and externally it can be applied as an ointment.

14. NATRUM MUR: For Urticaria after exertion

Symptoms:

The patients requiring this medicine develop Urticaria after exertion.

The hives itch and burn intolerably. The hives are whitish in appearance.

The skin is extremely greasy. The skin complaints are aggravated by eating excess salt and at the seashore.

Dosage and potency:

200C, 1M potencies often yield brilliant results. One shouldn’t repeat it too frequently.

15.TRIOSTEUM PERFOLIATUM: For Urticaria from gastric derangements

Symptoms:

The patients requiring this medicine develop Urticaria from gastric derangement.

The developed wheels are very itchy.

They loath food. They develop nausea on waking up in the morning, followed by vomiting and cramps in the abdomen.

Dosage and potency:

30C potency 3-4 pills every 2-3 hourly till the intensity of symptoms decreases.

16.APIS MELLIFICA: For Urticaria after insect bites

Symptoms:

Hives develop after bites, and they itch intolerably. Edematous swelling is noticed all most all over the body.

Swellings are sore and sensitive with stinging pain. The patients develop large Urticaria, which is rough, rosy red, sensitive, and sore.

The skin is dry, hot, and alternates with the gush of sweat.

Dosage and potency:

one should use 30C potency in edematous conditions. One shouldn’t repeat it too frequently.

17.ARSENIC ALBUM: For Urticaria with burning and restlessness

Symptoms:

The patient develops hives after eating shellfish. The hives burn violently, making the patient extremely restless.

The skin of the patient is extremely dry, rough, scaly, dirty, and faded.

Skin symptoms alternate with internal affection in such individuals.

Itching, burning with swelling at the affected site is very much marked.

Dosage and potency:

200C, 1M potency will often yield the best results.

Repetition will depend upon the severity of symptoms and state of the patient.

READ MORE ABOUT ARSENIC ALBUM

18.BOVISTA: For Urticaria from emotional excitement

Symptoms:

Bovista has marked action on skin with marked languor and tiredness.

Urticaria is developed by even little excitement with rheumatic lameness, palpitation, and diarrhea.

The wheals of urticaria itch on getting warm. Urticaria worsens on waking up in the morning and bathing.

The skin of the patient is so sensitive that the blunt instrument leaves a deep impression.

Dosage and potency:

30C, 200C potency shall be administered to the patient. Repetition would depend upon the state of the patient.

19.DULCAMARA: For Urticaria brought on from the sour stomach

Symptoms:

The patients requiring dulcamara develop Urticaria from being exposed to cold weather or from a sour stomach.

The itching is always worse in cold, wet weather. Urticaria appears as a red spot on the skin.

These rashes are seen in the newborn, and Dulcamara is an excellent remedy for Urticaria in infants.

Dosage and potency:

30C, 200C potency with frequent repetition till improvement is seen.

READ MORE ABOUT DULCAMARA

20.PSORINUM: For Urticaria after every exertion

Symptoms:

The patient develops Urticaria after every exertion.

The itching is intolerable, which worsens from the heat of the bed.

The patient scratches the wheals until it bleeds. Complaints reappear every winter.

Dosage and potency:

200C and higher potencies in a single dose. one shouldn’t repeat it too often. Psorinum takes nine days before it manifests its action, and even a single dose may elicit the action lasting for weeks.

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