Urticaria - Hives

Urticaria is a common skin problem characterized by development of itchy, transient weals (red patches) on the body. The number of weals and the severity of the condition is highly variable. These can also be associated with swelling of lips or any other part of the body.

    Urticaria occurs because of release of some mediators like histamine and serotinin in the body from immune cells resulting in a state of dilatation of blood vessels and increased leakiness of vessels resulting in collection of fluid in the skin; as this fluid gets reabsorbed the lesions disappear. The trigger for release of these mediators can be allergic or even non-allergic. Traditionally it was always considered that the main cause of urticaria was an immediate hypersensitivity reaction to an allergen that entered our body by way of ingested food or medications, inhaled pollen & dust etc or injected allergen like medications or insect bites. But now it is understood that very few of the urticaria are actually caused by a hypersensitivity reaction. In many of cases of urticaria the trigger cannot be identified.

          Sometimes urticaria can be associated with life threatening situration where because of laryngeal edema patients might suffer from choking sensation and if not treated urgently with appropriate medication it can result in death. So anytime there is a choking or breathing difficulty associated with urticaria it is very important to rush to a nearby hospital immediately. These situation are handled by injection of adrenaline.

          In case of a hypersensitivity reaction the triggers can be anything and subjective, so it’s very difficult to identify a trigger as anything can trigger it. Some foods are commonly implicated they include Foods with artificial coloring agents, Sea foods - fish, prawns, egg, peanuts, cashew nuts, chocolates, milk derivatives - cheese, panneer, khova, soya, Tomatoes, drumsticks, Strawberry etc.

Treatment of urticaria can be challenging as it is very difficult to identify the triggers. Treatment might involve long term use of antihistamines. Different individuals respond to different antihistamines. The optimal aim of treatment is to have reasonably good control of rashes with as minimum medicines as possible.

Many a times urticaria may go into remission but the duration of time required for tolerance to develop is unpredictable.

Psoriasis

Psoriasis is another chronic non-infectious skin condition characterized by occurrence of red or skin colour patches on various parts of body with scaling on them. The common sites of occurrence of psoriasis are back of elbow, front of knee, lower back, scalp, palms & soles but any body site may be involved.
Psoriasis occurs in various clinical forms, varying from occurrence of small scaling uniformly sized patches to geographic patches covering large areas of the body. Rarely almost entire skin surface may be involved with redness and scaling.
The cause of psoriasis is not known, but in some of the patients a family history is seen. It is caused due to some inflammatory mediators in the skin that cause increased rate of turnover of epidermal cells. There are several known triggers of psoriasis like infections, medications, stress etc. Alcohol and smoking have been found to worsen psoriasis.
Treatment options for psoriasis are several but till now drug has been found that can cure psoriasis. It can definitely be controlled with many of the treatment options available. The treatment option depends on the extent of body surface area involved, age of the patient, sex of the patient and the type of psoriasis that the patient is suffering.
Stress and anxiety are known to worsen psoriasis, worsening is also seen during the winter months. Patients with psoriasis need to understand that currently there is no cure available for it, but they need not loose heart there are several treatment options to control the disease. Don’t loose hope if your having psoriasis, it can be definitely controlled and you can lead a normal life.

Vitiligo

Vitiligo is a disorder characterized by appearance of white patches on various parts of the body. Vitiligo is an autoimmune disorder where the melanocytes which are the pigment producing cells in our skin are damaged. The exact cause for vitiligo is not known but several factors play an important role like genetic factors, stress, exposure to various chemicals etc.
Vitiligo is associated with lot of stigma, as colour forms an important part of appearance of an individual. Most of the stigma associated with vitiligo is unfortunate as it’s a simple non-contagious disorder. Patient suffering from vitiligo suffer from a severe depression and withdraw themselves from the society. This stress regarding the disease itself can cause worsening of vitiligo.
Vitiligo rarely can be associated with other autoimmune disorders like thyroid disorders, pernicious anaemia, alopecia areata etc. Vitiligo usually has an onset in 2nd to 3rd decades of life. The childhood vitiligo is also not very uncommon. The onset is most often related with a stressful event like loss of parent, loss of job etc.
Vitiligo appears as several clinical forms like
1. Focal vitiligo – appears as few white patches
2. Generalized vitiligo – where there is appearance of white patches all over body
3. Universal vitiligo – where almost entire colour the skin is lost
4. Segmental vitiligo – appears as localized white patches on one side of the body
5. Lip-Tip vitiligo – appears as white patches on lips and surrounding mouth and tip of fingers
In some of the cases the hair in the white patches can also become white. The characteristic feature of white patches in vitiligo is that the texture of the skin is entirely normal. The diagnosis of vitiligo is almost always clinical, rarely are some investigations required.
Treatment options for vitiligo are plenty, but as it is a chronic disease the treatment is prolonged and it may require treatment for 1-2 years, depending on the response. The various medical options for vitiligo include
1. For localized vitiligo – steroid ointments may be helpful or topical psoralen ointment or lotions can be used followed by exposure to sunlight.
2. For generalized vitiligo – systemic psoralens given with UVA or Sunlight is helpful. A good therapeutic option is Narrow-band UVB, with which the response is good and can be used in children. This phototherapy is given for 2-3 times/week and need to be continued for 3-6 months depending on the tolerance of the individual. It is a safe treatment without much adverse effects. For a vitiligo that is unstable and spreading a course of oral steroids for few weeks may be required to stabilise the disease.
3. Segmental vitiligo – doesn’t respond that well to treatment and is a very stable disease. Surgical management is a good option for segmental vitiligo.
4. Lip-tip vitiligo – It responds poorly to the medical line of treatment, surgical management is a good option provided the disease is stable.
5. Newer medical line of treatment includes use of immunomodulator creams like Tacrolimus, pimecrolimus. Beta-fibroblast growth factor lotion, lotion containing pseudocatalase and other enzymes. Excimer lasers can be used in management of vitiligo.
6. Diet – diet has no major influence on the course of vitiligo. But it is recommended that the patient reduces the intake of sour foods like lemon, orange, tomatoes etc.
7. Camouflaging with permanent make-up, tattoos can be used.
8. Advise for the patients suffering with vitiligo
Ø Have a positive attitude, don’t get depressed vitiligo can be treated
Ø Consult a good dermatologist, have patience as the treatment may be prolonged and in early part the response may not be dramatic
Ø Avoid injuries as vitiligo can develop at site of any types of trauma
Ø If the disease is widespread and sun exposed area is involved use a broad spectrum sunscreen to protect the skin.
Ø Follow the advice given by your doctor.
9. Surgical options for management of vitiligo require the disease to be stable. The type of procedure used depends on the shape of the patch, site and size. The various options used are
Ø Split-thickness skin grafting
Ø Miniature punch grafting
Ø Suction-blister grafting
Ø Melanocyte transplantation
Ø Dermabrasion
Ø Needling