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Pressure urticaria in Child
Other Resources UpToDate PubMed

Pressure urticaria in Child

Contributors: Nnenna Agim MD, Kimberley R. Zakka MD, Laurie Good MD, Whitney A. High MD, JD, MEng, Eric Ingerowski MD, FAAP, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Pressure urticaria is a type of chronic, physical, inducible urticaria characterized by a wheal-and-flare response of the skin to sustained pressure stimuli. It is usually a chronic condition that lasts for more than 6 weeks. Presumably, it occurs by a pressure-related mechanism that results in mast cell degranulation with release of histamine.

Pressure urticaria can be seen in newborns and young infants and most often involves the feet and lower legs as well as the torso, but it may involve other parts of the body. It is unknown if this causes physical discomfort such skin burning, pain, or itching in infants as reported in adult patients. Pressure urticaria has less commonly been described in children.

Pressure urticaria may be induced by pressure from elastic bands of clothing (socks), undergarments, car seat or baby swing straps, and cushions. It may also be seen when infants repetitively kick their feet against an object. Older children may have involvement where straps of backpacks or sports equipment contact the skin.

Occasionally, the lesions of pressure urticaria may be mistaken as unexplained bruises or physical abuse that may result in unnecessary child protective referrals. Pressure urticaria is thought to be uncommon, but the true incidence is unknown.

Two forms of pressure urticaria are recognized: immediate pressure urticaria (IPU), also known as dermographism, and delayed pressure urticaria (DPU). In IPU, swelling and erythema of the skin begin within minutes of the offending pressure stimulus, versus DPU, which takes 4-8 hours for a reaction to develop.

Lesions in pressure urticaria may last for 8-72 hours, a range that is much longer than that of most other forms of urticaria.

Systemic symptoms including wheezing, hypotension, and fevers are very uncommonly seen in infants.

Codes

ICD10CM:
L50.8 – Other urticaria

SNOMEDCT:
387787005 – Pressure urticaria

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Angioedema – Urticaria and angioedema share a similar pathogenesis, but angioedema manifests with deeper involvement and involves the mucosal tissue. Angioedema may involve the skin, larynx, and buccal and gastrointestinal mucosa.
  • Urticarial vasculitis – A form of leukocytoclastic vasculitis associated with connective tissue disease and hepatitis C.
  • Erysipelas – This is a superficial form of cellulitis caused by group A Streptococcus. Like all forms of cellulitis, erysipelas usually begins as a regional infection; drawing a line along the leading edge to monitor for continued direct expansion is used to follow the patient clinically. Onset is acute, the skin may be quite warm, and the child may have a fever.
  • Contact dermatitis – This is caused by direct irritation or a hypersensitivity response to a skin contactant. This frequently has sharp circumscription and unusually sharp edges that suggest an exogenous etiology. Blistering and erosions or an eczematous dermatitis may accompany this finding.
  • Lymphedema – Unlike pressure urticaria, which waxes and wanes, lymphedema is a persistent impairment of lymphatic drainage that leads to nonpitting edema in the affected area. Erythema is very unusual; segmental involvement of the extremities is typical.
  • Other forms of physical urticaria: cold and heat, solar, and vibratory.
  • Bruising – Pressure-induced urticaria can cause a bluish-purple color change to skin, but it will resolve in 48-72 hours, unlike a bruise, which will persist longer.
  • Child abuse – Pressure urticaria may be mistaken as skin lesions consistent with physical abuse.

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Therapy

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References

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Last Reviewed:08/30/2022
Last Updated:09/11/2022
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Pressure urticaria in Child
A medical illustration showing key findings of Pressure urticaria (Adult) : Pruritus
Clinical image of Pressure urticaria - imageId=2790876. Click to open in gallery.
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