How to treat delayed-pressure urticaria
Delayed pressure urticaria (DPU) is caused by sustained pressure applied to the skin. Wheals forms after a delay of 30 minutes to 12 hours and may last 12 to 72 hrs. Because lesions may last for more than 24 hrs, it may be mistakenly diagnosed as urticarial vasculitis. Delayed pressure urticaria wheals are often deep and may look like angioedema. Delayed pressure urticaria may also coexist with chronic urticaria. It can negatively affect quality of life.
Sites affected with delayed pressure urticaria
- Skin under Tight clothing.
- Buttocks and lower back after sitting.
- On hands after manual work.
- On the feet after walking.
- Genitalia after intercourse.
Clinical picture
- Wheals are itchy but may be also painful.
- Associated symptoms include malaise, flu like symptoms, muscle and joint pain and increased white blood cells.
General tips to treat delayed pressure urticaria
- DPU is difficult to treat and may require oral corticosteroids in severe cases.
- Avoid tight clothing.
- Antihistamines are usually ineffective.
- Gluten-free diet may be helpful in some cases.
Medical treatment options
- Second generation H1 antihistamines
- Cetirizine: adult dose 10 mg/day.
- levocetirizine: 5 mg once daily.
- Loratadine: adult dose 10 mg daily.
- Desloratadine: adult dose 5 mg daily.
- Rupatadine: adult dose 10 mg daily.
- Fexofenadine (adult dose 180 mg/day).
- Leukotriene receptor antagonists
- Desloratidine 5 mg daily in addition to Montelukast 10 mg once daily.
- Montelukast 10 mg once daily with Loratadine 10 mg once daily.
- Topical corticosteroids
- Clobetasol propionate 0.05% twice daily for 6 weeks.
- Oral corticosteroids
- Prednisolone 30-40 mg/d.
- Sulphones
- Dapsone : 50 to 100 mg daily.
- Sulphasalazine 2-4 g daily
- Sulfasalazine should only be considered in patients who are not sensitive to aspirin and other non-steroidal drugs.
- Side effects may include bone marrow depression and hypersensitivity reactions.
- Omalizumab : 150 mg every 2 weeks or 300 mg every 4 weeks.
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