URTICARIA E PRESSIONE: A CASE REPORT

Abstract

Urticaria is a monomorphic dermatosis characterized by dermal edema as a result of vasodilatation of blood vessels. Urticaria is a characteristic efflorescence for urticaria, and in 40-45% of cases it is accompanied by angioedema. Urticaria is a limited, more or less elevated, intensely pruritic plaque, usually red in color but it can be pinkish or whitish, which persists from a few minutes to 24 hours, but new changes can appear constantly and sometimes the urticaria confluent with each other, causing produce larger figured changes with peripheral spread and central regression.Sometimes urticaria can be followed by angioedema, which is a more or less pronounced circumscribed edema localized anywhere on the skin or mucous membranes and resolves within 72 hours. I present a case report of a 55-year-old female patient who for the first time ин three years ago developed erythema and edema of the palms followed by intense itching, treated with antihistamine and corticosteroid therapy, during which the changes subsided. The patient does not provide information about allergic diathesis or contact with any allergen. From past illnesses, he was diagnosed with Hypothyroidism 30 years ago and is being treated with Levothyroxine 50 mg tablets. In an interval of several weeks or months, the changes appear again and are always of different intensity from minimal urticarial morphs to generalized urticarial changes all over the body with edema mostly in the facial region. The patient was treated with several modalities of systemic and per os corticosteroid and antihistamine therapy, but without fully achieving the desired effect. The patient underwent numerous investigations, of which elevated reference values were in anti-TPO 405.63 (0.00-5.61), anti dsDNA-74.2IU/ml, kappa/lambda light immunoglobulin classes in serum – 3.08g/l and a diagnosis was made Urticaria e pressione, which was further placed on therapy with Methotrexate with an initial dose of 10mg with a gradual increase to 20mg over a period of 6 months but without significant effect, the patient continued her treatment in а dermatological center outside the country where, based on the treatment protocols, treated with cyclosporine 100 mg (1.5 mg/kg) for a period of 2 months, but without success, and treatment with monoclonal antibodies Omalizumab 300 mg s.c. once a month for a period of 6 months, while after the first 2 doses the changes are in complete regression and he has been without any symptoms and signs for months.