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Histopathology of Urticaria

  • Urticaria and Atopic Dermatitis (M Hide, Section Editor)
  • Published:
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Opinion statement

Purpose of review

Urticaria is a common skin manifestation with many different causes. It is characterized by local or generalized edematous erythema with itching and increased blood flow and vascular permeability. Individual urticaria lesions typically last less than 24 h (usually less than 12 h), but new lesions may appear and resolve sporadically. Since the diagnosis is usually made based on the history and clinical appearance of the lesions, skin biopsy is not necessarily performed, but it is recommended for evaluating patients with refractory eruptions or suspicion of other diseases exhibiting urticaria-like lesions. The histopathological features of urticaria are dermal edema and perivascular and interstitial inflammatory cell infiltration, and there is only minimal change in the epidermis. Cellular infiltrates are composed of lymphocytes, neutrophils, and eosinophils.

Recent findings

In our 64 patients with urticaria, severe edema was found in 48 cases (75%) with mixed cellular infiltration in 45 (70%), lymphocytic infiltration in 17 (27%), and neutrophilic infiltration in 2 cases (3%). Perivascular infiltration was found in 35 cases (55%), and the others were classified into the perivascular and interstitial infiltration type. Subcutaneous cellular infiltration has been shown to be associated with poor treatment response.

Summary

In this review, we summarize the histopathological findings of urticaria and its differential diagnosis. Evaluation of the histopathological features may provide further insight into the mechanism of urticaria and potentially provide valuable information to develop more effective treatments.

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Authors and Affiliations

  1. Department of Dermatology, Fukuoka Dental College, Fukuoka, Japan

    Eriko Itoh MD & Minao Furumura MD, PhD

  2. Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Eriko Itoh MD & Masutaka Furue MD, PhD

Authors
  1. Eriko Itoh MD
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  2. Minao Furumura MD, PhD
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  3. Masutaka Furue MD, PhD
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Corresponding author

Correspondence to Eriko Itoh MD.

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Conflict of interest

Dr. Eriko Itoh, Dr. Minao Furumura, and Dr. Masutaka Furue declare that they have no conflicts of interest.

Human and animal rights and informed consent

With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

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This article is part of the Topical Collection on Urticaria and Atopic Dermatitis

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Itoh, E., Furumura, M. & Furue, M. Histopathology of Urticaria. Curr Treat Options Allergy 4, 450–457 (2017). https://doi.org/10.1007/s40521-017-0144-2

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  • DOI: https://doi.org/10.1007/s40521-017-0144-2

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