Specialty dermatology ICD-9-CM 708.5 eMedicine derm/442 | ICD-10 L50.5 DiseasesDB 29573 | |
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Cholinergic urticaria (CU) is a type of physical urticarias (or hives) that appears when a person is sweating.
Contents
Symptoms
CU typically presents with a number of small, short-lasting hives but may also involve cutaneous inflammation (wheals) and pain which develops usually in response to exercise, bathing, staying in a heated environment, or emotional stress. Although the symptoms subside rapidly, commonly within 1 hour, CU may significantly impair quality of life, especially in relation to sporting activities.
Prevalence
Though overall research is limited, various studies indicate that CU is relatively common across populations with prevalence rates reportedly ranging from 5% to 20% (depending on locale, race, and age). The condition is more common in young adults, and prevalence appears to peak in adults aged 26–28 (up to 20%). The vast majority of cases are reported to be mild, and proportionally few individuals seek medical attention regarding the condition.
Causes
Sweat hypersensitivity
This subtype of CU refers to those who are hypersensitive to their own sweat.
Diagnosis
Diagnosis is made by injecting autologous (the person's own) sweat into the skin.
Features
The hives are observed to coincide with perspiration points of sweating.
Pathophysiology
Tanaka et al. found that the sweat hyper-sensitivities of CU and atopic dermatitis seem to be virtually the same, and therefore, the sweat-induced histamine release from basophils may also be mediated by a specific IgE for sweat in atopic dermatitis as well as CU.
Treatment
Acquired anhidrosis and/or hypohidrosis
This subtype of CU refers to those who have abnormally reduced sweating.
Diagnosis
Sweat is readily visualized by a topical indicator such as iodinated starch or sodium alizarin sulphonate. Both undergo a dramatic colour change when moistened by sweat. A thermoregulatory sweat test evaluates the body’s response to a thermal stimulus by inducing sweating through the use of a hot box ⁄ room, thermal blanket or exercise. Failure of the topical indicator to undergo a colour change during thermoregulatory sweat testing can indicate anhidrosis and/or hypohidrosis (see Minor test).
A skin biopsy may reveal cellular infiltrates in sweat glands or ducts.
Features
Severe heat intolerance (e.g., nausea, dizziness, and headache), and tingling, pricking, pinchy or burning pain over the entire body on exposure to hot environments or prolonged exercise which improve after cooling the body. Occurs in the absence of any causative skin, metabolic, or neurological disorders.
Pathophysiology
The wheals, hypohidrosis, and pain seems to result from the low expression levels of acetylcholinesterase (AchE) and cholinergic receptor, muscarinic 3 (CHRM3) in the eccrine gland epithelial cells.
Elevated expression levels of CCL2/MCP-1, CCL5/RANTES and CCL17/TARC which result in chemoattracted CD4+ and CD8+ T cell populations to the surrounding area may be responsible for exerting a downmodulatory effect on the AchE and CHRM3 expressions.
Corticosteroid inhibits the expressions of CCL2/MCP-1, CCL5/RANTES and CCL17/TARC. This further support the notion that CCL2/MCP-1, CCL5/RANTES and CCL17/TARC play a crucial role.
Treatment
Idiopathic
Unknown or unclassified at this time. This represents those who do not fall under any of the above categories.
History
CU was first described by Duke in 1924. The term cholinergic is derived from the finding that hives similar to those of CU can be evoked using cholinergic agonists (e.g. methacholine).