Urticaria

Urticaria is an affection of the skin characterized by the development of white or reddish elevations termed wheals, which are accompanied with more or less pruritus. These wheals may be few and localized, or, more frequently, they exist in considerable number, and are generalized.

Not infrequently a little heat and itching first appear; and, if the part be rubbed or scratched, the wheals be­come manifest. The elevations may last for a few minutes only or for a few hours, and disappear, leaving no trace behind. Later in the day, or perhaps the next day, a renewal of the eruption occurs, and these may be repeated for a few days or persist for months, constituting a chronic urticaria.

The degree of pruritus varies; it may be hardly more than an agreeable sensation, or may be snllicicnily severe to constitute a veritable torture. The scralrliiug will, of course, be commensurate with the itching, und lead to more or less excoriation and even deep wounding of the skin.

The wheals are chiefly met with on the covered portions of the body, and their appearance is favored by warmth frequently disappearing if the parts be exposed to, a draught of cold air. Thus it not infrequently happens that a patient may have a severe attack at home, bur, by the time he reaches the physician, all signs of the eruption will have disappeared, or perhaps there will be nothing visible on the skin except a few insignificant scratch marks. In these cases, if the finger nail or the point of a pencil be sharply drawn across the skin, it will be followed by a white line, which in a few moments becomes elevated and red, and lasts for a brief period, and then disappears.


Urticaria presents certain peculiarities, according as it occurs in the adult and the child, owing, in the latter, to the greater sensitiveness of the skin, and the tendency to the deposition of lymph in the site of the wheals. Some authors treat of urticaria in the adult and in the child. I think this is entirely unnecessary and apt to lead to confusion.

The chronic forms may result from the acute, or develop out of a state of tolerable health, and without appa­rent cause. There is little pyrexia present in chronic urticaria. When the crops of wheals are of pretty long continuance, the disease is called U. perstans. In other cases the wheals are small and very fugitive; but the skin is irritable, and the itching intense. This is U. evanida. The name of factitious urticaria has been given to that form of the disease which is easily produced by mechanical irritation, and is not idiopathic.

It occasionally happens that in the formation of wheals, instead of serum being poured out, a certain amount of hemorrhage occurs. This effusion of blood in connection with the escape of serosity from the vessels is not confined to urticaria, but may take place under certain circum­stances in connection with almost every skin affection which is hyperaemic and inflammatory. When the effusion is conjoined with the development of wheals, the blood generally raises the cuticle somewhat, and produces what is called purpura urticans. The cuticle sometimes bursts, and exposes a reddened surface that does not heal, and whence a certain amount of bloody fluid may ooze for a while. The name of Urticaria hemorrhagica has been given to this latter disease, and it includes the so-called purpura uriticans. The hemorrhage, however, is a mere epiphenomenon, though it indicates a purpuric tendency. These little hemorrhagic wheals are sometimes seen about the neck and face of nervous women and elderly men out of health.