Acute urticaria happens equally in men and women; but chronic urticaria seemed to be more common in women. The diagnosis of urticaria is based on the signs and symptoms of the patient, and the history of exposure to allergens.
Urticaria causes significant distress in terms of the symptoms produced, however prognosis is excellent as it is not life-threatening. About myVMCVirtual Medical Centre is Australia’s leading source for trustworthy medical information written by health professionals based on Australian guidelines.
Please be aware that we do not give advice on your individual medical condition, if you want advice please see your treating physician.
Please note that we are unable to respond back directly to your questions or provide medical advice. Chronic cutaneous lupus or discoid lupus is characterized by chronic inflammatory lesions on the face, scalp, ears and other parts of the body.
The discoid lupus lesions might even appear as firm lumps in the subcutaneous fat layer beneath the skin. Subacute cutaneous lupus appears as red scaly patches or red ring-like lesions with scaly edges on the neck, shoulders, arms, trunk and face.In acute cutaneous lupus, red rashes appear on the face in a butterfly pattern. Severe lupus flare-ups in the scalp might damage the hair follicles, leading to hair loss or alopecia.
For unknown reasons, people who experience recurrent Epstein-Barr infections have a higher risk of developing lupus.
Protecting the skin from the solar radiation is the key task of lupus patients suffering from lupus rash. If your skin becomes excessively dry, you can use a suitable moisturizer for hydrating the skin.
The good news is it’s not contagious or life-threatening, but it can be awfully painful and uncomfortable. On that note, to treat contact dermatitis successfully, you first need to identify and avoid the cause of your reaction. When it comes to facts about dermatitis, a good starting point is the causes of dermatitis. In allergic contact dermatitis, as with any allergy, the body’s immune system reacts to an allergy-causing substance which isn’t normally harmful. The severity of symptoms really depends on how long you’re exposed, the cause and your genetic makeup, which may affect how you respond and eventually heal.
While the signs and symptoms of dermatitis aren’t pleasant, once you’ve experienced it, you’ll have a better idea about how to prevent a reoccurrence. Poison ivy is a plant that can cause an uncomfortable and unsightly rash, but it’s important to know that poison ivy rash affects some people more than others due to poor handling and that poison ivy treatment will go a long way in easing rash symptoms. Dermatitis herpetiformis is a skin rash from celiac disease which can be properly managed by following a gluten free diet. On any matter relating to your health or well-being, please check with an appropriate health professional. Solar urticaria is a skin condition known as hives that specifically develops after exposure to sunlight.
Urticaria, commonly known as hives, is a condition where the body’s inflammatory response is triggered for no apparent reason. It appears that in solar urticaria, there are substances within the bloodstream that are photosensitive or are only formed after light exposure. Histamine and possibly other inflammatory chemical mediators causes the blood vessels at om the affected are to dilate. The skin rash in these photos are of acute urticaria which is largely the same type of rash seen in solar urticaria. In this type of solar urticaria, the specific photoallergens responsible for the development of the condition are only present in hypersensitive individuals. In this type, the photoallergens may be present in both solar urticaria patients and healthy individuals. Solar urticaria may closely resemble other skin conditions caused by sunlight exposure (photodermatoses). Ask a Doctor Online Now!Light therapy (phototherapy) is done as a means to desensitize the skin to sunlight. Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis.
This page offers information about the red rash erythema (chronicum) migrans, which can develop after a tick bite, and which is characteristic of Lyme disease.
In case of an infection with the Lyme-bacterium Borrelia burgdorferi (Bb), a typical skin condition known as erythema migrans (EM) can develop at the location of the tick bite days to weeks after the tick bite.
Only in case of an infection with Borrelia burgdorferi, but note that not everyone that gets infected with Bb develops an erythema migrans, while an infected person may develop other symptoms later anyway. Typically a red rash develops, that expands gradually and often clears in the center, so that a ring is formed.
Do not confuse it with a small red spot that looks like a mosquito bite, which is just an irritation of the skin caused by the tick bite.
Pictures of the tick bite rash erythema migrans on the thigh of a child (upper left image), and an EM rash on the shoulder (upper right image).
Normally at the location of he tick bite, but it can also develop at other sites, and sometimes there can be multiple at the same time, when the bacterium has disseminated (spread) throughout the body.
If a typical erythema migrans occurs after a tick bite, then no further examination like blood tests is necessary. In national treatment guidelines typically a treatment of at most 14 days with antibiotics is advised.However, some doctors advise (and treat with) 6 weeks of higher dosed antibiotic treatment in case of an erythema migrans. Take a picture of the (suspected) erythema migrans and note the date of taking the picture; circle the erythema migrans with a ballpoint pen and take another picture a few days later, so that the enlargement of the rash can be shown.
Many people are bitten by a tick unnoticed and only a portion of the people who become infected will get an erythema migrans. At the time of the appearance of an erythema migrans antibiotics should be taken immediately, without waiting for results of tests. Flushing describes episodic attacks of redness of the skin together with a sensation of warmth or burning of the face, neck and, less frequently, the upper trunk and abdomen. Flushing can be an exaggeration of a physiologic process or a manifestation of a serious condition that needs to be identified and treated. Redness of the skin may be caused by an increased amount of saturated hemoglobin, an increase in the diameter or actual number of skin capillaries, or a combination of these factors.2 Flushing is caused by increased blood flow through the skin, causing warmth and, because of engorgement of the subpapillary venous plexus, redness. The diameter of the blood vessels of the cheeks is wider than elsewhere, the vessels are nearer to the surface, and there is less tissue thickness obscuring them. In some carcinoid tumors, fibrosis of the right side of the heart may lead to a combination of stenosis and regurgitation at the tricuspid valve, as well as pulmonary stenosis.
Heat causes flushing in many patients, and overheating can lower the threshold to flushing from other causes, such as menopause.3 Overheating, such as after exercise or sauna, can cause physiologic flushing because of the effect of the rise in blood temperature on the thermoregulatory center in the anterior hypothalamus. A useful maneuver for patients faced with a brief thermal exposure is to suck on ice chips carried in an insulated cup. A typical hot flush begins with a sensation of warmth in the head and face, followed by facial flushing that may radiate down the neck and to other parts of the body; it is associated with an increase in temperature and pulse rate and followed by a decline in temperature and profuse perspiration over the area of flush distribution.
The primary role of estrogen deficiency has been questioned and a deficit of thermoregulation has been proposed. Pharmacologic menopause with flushing can be induced by various drugs 4-hydroxyandrostenedione, danazol, tamoxifen, clomiphene citrate, and leuprolide. Other medications that can cause flushing are corticotropin- releasing hormone, doxorubicin, and niacin (Box 1).
Adapted from Cutaneous manifestations of disorders of the cardiovascular and pulmonary systems.
Trichloroethylene, a chemical that has been abandoned in recent years because of its carcinogenic potential, can cause flushing. Carcinoid syndrome describes the manifestations of carcinoid tumors-flushing, bronchoconstriction, gastrointestinal hypermotility, and cardiac disease. Corticosteroids, phenothiazines, and bromocriptine have been effective in the treatment of patients with bronchial carcinoid tumors. In some patients, failure of medical treatment may necessitate carrying out hepatic artery embolization. Mastocytoses are benign proliferative disorders of the reticuloendothelial system and familial cases have been reported. Symptoms of mastocytosis are mainly the result of release of products of mast cell activation. Episodic bright red flushing occurs spontaneously or after rubbing the skin or exposure to alcohol or mast cell degranulating agents. The range of substances secreted by medullary carcinoma of the thyroid is considerable, whether sporadic or familial. This describes hemifacial flushing and sweating sometimes associated with warmth and anhidrosis of the contralateral arm and leg (Fig. This syndrome usually manifests as immediate unilateral or bilateral flushing, sweating in the distribution of the auriculotemporal nerve, or both in response to gustatory or tactile stimuli. A series of three male patients with secondary hypogonadism has been described, in whom flushing was associated with elevated 24-hour urine 5-HIAA levels. Treatments that lower the serum testosterone level, such as orchiectomy or luteinizing hormone-releasing hormone analogues, cause hot flushes in more than 50% of men. Cheung and colleagues20 have described a family with monoamine oxidase deficiency causing episodes of flushing affecting the face and chest precipitated by emotion or certain foods, followed by diarrhea, headaches, and sometimes palpitations.
It is important to differentiate physiologic flushing from flushing associated with more serious diseases.
Alcohol and certain foods can cause physiologic flushing but may also trigger flushing in carcinoid syndrome.
Vercellini P, Vendola N, Colombo A, et al: Veralipride for hot flushes during gonadotropin-releasing hormone agonist treatment. Rubin J, Ajani J, Schirmer W, et al: Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant car-cinoid syndrome. Shakir KM, Jasser MZ, Yoshihashi AK, et al: Pseudocarcinoid syndrome associated with hypogonadism and response to testosterone therapy. Smith JA Jr: Management of hot flushes due to endocrine therapy for prostate carcinoma [review].
Regardless of the cause of urticaria, the treatment options are generally successful in controlling the symptoms.
This include limiting outdoor exposure, shutting windows, avoiding the drugs that are identified, etc. It is effective in reducing symptoms such as itchiness (this is the most distressing symptoms for patients with urticaria). In individuals who have persistent or recurrent attacks of acute urticaria (or associated with angioedema), they may respond to steroid therapy.
It can affect several organs of the body including the heart, kidneys, joints, blood vessels, lungs, brain and the skin. This form of lupus rash is more common in people diagnosed with systemic lupus erythematosus. Health experts believe that genetics and exposure to certain environmental factors might make a person susceptible to lupus.


Epstein-Barr is a common viral infection that causes symptoms such as sore throat, cough, cold and fever. According to health experts, even lupus patients without skin rashes should shield the exposed parts of the body from the ultraviolet light. These are made with fabrics with unique weave structure that shields the skin from the ultraviolet rays. Add enough fresh fruits, vegetables, lean proteins, fish and whole grains in the daily diet. Essentially, it’s any red, inflamed skin reaction to coming into contact with something that it finds irritating. Then if you can avoid the problematic substance, the rash usually clears up in two to four weeks. Those jobs that require frequent exposure to heat and water, such as food preparation, dishwashing, hair styling, janitorial staff, even health care professionals, can make skin more prone to irritant contact dermatitis. Understanding what causes dermatitis – and allergic triggers to which you may be prone – go a long way to protect yourself. Dermatitis herpetiformis (DH) is a skin rash which resembles herpes lesions which can appear as blisters and bumps but it is not a form of herpes. Types and symptoms of pneumoniaSebaceous cyst, noncancerous small lump behind the ear, beneath the skinHypothyroidism vs. No statement herein is to be construed as a diagnosis, treatment, preventative, or cure for any disease, disorder or abnormal physical state.
Sometimes it can be associated with contact with certain substance but hives in most people comes and goes without any trigger or treatment.
For example, bacteria and viruses have proteins on their surface which are considered as antigens. The blood flow increases to the affected area and fluid leaks into the tissue from the bloodstream thereby leading to swelling. It is similar to acute urticaria except that it is distributed along the sun-exposed areas. Sometimes the affected area in solar urticaria may be clearly demarcated from the neighboring unaffected areas that were adequately protected by clothing. Sunlight and other artificial light sources emitting light within a certain wavelength range are the triggering factor but not the actual cause.
The reaction is more likely to occur in areas that are not usually exposed to sunlight like the back whereas other areas, such as the face and hands, which are usually exposed to sunlight daily tend not to be affected.
A type of antibody known as IgE (immunoglobulin-E) binds to the photoallergen and mediates the reaction. The rash develops within 30 minutes of sun exposure and resolves within minutes or hours once out of the light. The light sources to be used includes ultraviolet light (less than 400nm) and visible light (between 400 to 800nm). Even if sun exposure is minimized, it should not be to the point where it is hampering a person’s social and occupational commitments.
It may also be useful to some degree as a preventative measure (prophylaxis) but has limited efficacy in this regard. Just as the sun-exposed areas become acclimatized to sunlight in solar urticaria, phototherapy may be able to desensitize affected areas to some degree.
This erythema migrans mark is popularly also called tick bite, but on this site that term is used for referring to the bite of a tick. It would be best to take a photo (or photos) every day, so that the progress of the rash can be seen. The erythema migrans is sometimes also difficult to see, because it is very light, or because it is hidden from the eye (like under the hair or on the back). No time should be wasted unnecessarily: the longer one is infected, the harder it is to cure.
It is the transient nature of the attacks that distinguishes flushing from the persistent erythema of photosensitivity or acute contact reactions. A biochemical workup of every case of flushing is neither practical nor cost-effective; in this chapter, we present guidelines that will help determine when a workup is warranted. This may explain why flushing occurs in that limited distribution.3 Polycythemia produces the characteristic ruddy complexion, but it may also cause a peculiar coloration termed erythremia, which is a combination of redness and cyanosis. A similar mechanism is responsible for facial flushing caused by hot drinks, which produce a rise in temperature of blood in the oral cavity, in turn leading to an increase in temperature of blood perfusing the hypothalamus. A similar syndrome may also occur in men with prostate cancer receiving treatment with gonadotropin-releasing hormone analogues, such as buserelin.
Certain characteristics suggest the diagnosis of climacteric flushing, such as drenching perspiration, a prodromal sensation of overheating before the onset of flushing and sweating, and waking episodes at night, with the typical symptoms. When inhaled following ingestion of alcoholic beverages, a striking cutaneous reaction results, consisting in the sudden appearance of erythema of the face, neck, and shoulders, a reaction that has been termed degreaser’s flush. This gustatory flushing is caused by a neural reflex involving autonomic neurons carried by the branches of the trigeminal nerve. Oral challenge with MSG has failed to provoke flushing in volunteers with a history of MSG flushing. Carcinoid tumors are neuroendocrine tumors derived from a primitive stem cell that may differentiate into any of various adult endocrine-secreting cells, producing peptides, hormones, and neurotransmitters. With time, the flushing may appear without provocation.9 The character of the flush differs, depending on the site of origin of the tumor (Figs.
In general, the larger the primary tumor, the greater the likelihood of metastasis, which provides prognostic implications.9 Carcinoids of the appendix and rectum rarely manifest with the carcinoid syndrome. Flushing seen with ileal carcinoids cannot be explained solely by the production of serotonin.1 Serotonin may or may not be released into the circulation during flushing, and IV infusion of serotonin does not cause flushing.
The degree of elevation of 5-HIAA does not always correlate with the severity of flushing.9 Excretion fluctuates, so that repeat measurements may be necessary. This treatment is based on the dependence of metastatic malignant tissue but not healthy liver parenchyma on an intact hepatic arterial blood supply. Plasma histamine levels are frequently increased in patients with systemic symptoms, and elevated urinary excretion of histamine and its metabolite methyl imidazole acetic acid (MIAA) can also be seen. Flushing attacks may be accompanied by headache, dyspnea and wheezing, palpitations, abdominal pain, diarrhea, and syncope and may closely resemble the flushing episodes of the carcinoid syndrome, especially the foregut variety, which are also mediated by histamine. In adults, this syndrome is a well-recognized sequela of parotid surgery, trauma, or infection. Flushing disappeared, and 5-HIAA levels normalized after starting testosterone enanthate treatment. Lack of regulatory feedback in the hypothalamus from circulating serum testosterone is the presumed mechanism. Blood serotonin levels in this family were elevated secondary to decreased activity of monoamine oxidase.
If flushing occurs at all, it is seen after a paroxysm of hypertension, tachycardia, palpitations, chest pain, severe throbbing headaches, and excessive perspiration. Certain agents that trigger the flush suggest an underlying systemic disease as the cause for the flushing, such as mastocytosis and carcinoid syndrome.
Associated features may include respiratory symptoms, gastrointestinal symptoms, headache, urticaria, facial edema, hypertension, hypotension, palpitations, or sweating. Temporal characteristics are the frequency of the flushing and the timing of the specific features during each flushing reaction.
The rashes of acute urticaria are characterised by a rapid onset and rapid resolution within several hours. However resolution time in chronic urticaria is longer – sometimes up to 36 hours before resolution. Chronic urticaria lasts for more than 6 weeks, hence it can cause significant distress to the patient. Skin problems developing out of lupus are divided into three main categories – chronic cutaneous lupus, also known as discoid lupus, subacute cutaneous lupus and acute cutaneous lupus. Roughly, 10 per cent of discoid lupus progresses to systemic lupus erythematosus, which causes chronic inflammation in other organs of the body. People with active systemic lupus erythematosus might develop vasculitis that appears as red spots or small bumps on the skin, usually on the skin of the lower legs.
After the symptoms of the viral infection subsides, the virus remains in the immune system in a dormant state. Health experts speculate that in lupus patients, the ultraviolet radiation might trigger production of certain proteins on the surface of the skin. For unknown reasons, exposure to sunlight triggers production of antibody that triggers lupus flare-ups.
The standard sunscreen products usually feature only a SPF number that indicates the level of protection against the ultraviolet B rays of the sun. Omega-3 fatty acids found in fish, flaxseeds and walnuts might reduce the chronic inflammation. Herbalists claim that evening primrose oil might be beneficial for people diagnosed with lupus. That depends on identifying what’s causing the reaction, and if the condition is because of a food or substance allergy you may have in allergic contact dermatitis. Quick remedies include soothing your skin with cool, wet compresses and anti-itch creams and lotions. Although it normally affects the hands and forearms, it can occur in any part of the body that comes into contact with the substance. You’ll know soon enough – the reaction usually happens within minutes to hours of exposure and if you’re wondering how long does contact dermatitis last, you could be looking at an uncomfortable two weeks. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. Solar urticaria is a type of photodermatosis – a skin condition that arises with light exposure. Substances that cannot be identified in every case triggers the immune system’s activity and inflammation ensues.
A part of the immune system functions by making antibodies, another type of protein, which will bind with specific amtigens. The characteristic feature is that the skin rash develops after even short exposure to sunlight, usually less than 30 minutes. These areas may have acclimatized to sunlight and are therefore unaffected with solar urticaria.
However, the reason why only certain people will develop the condition and not others who also have the photoallergen within their body is unclear. Vitamin D deficiencies may also be a factor in patients who become obsessive with regards to sun exposure. Histamine receptor blockers and antimalarials may also be of some use in treating and preventing solar dermatitis eruptions. So, if no tick bite has been noticed and there is doubt about the diagnosis, then Lyme disease (Borrelia antibody) blood tests can be done. In the face, neck, and upper trunk, where flushing is most frequent, the neurologic control of vascular tone is predominantly exerted by autonomic vasodilator nerve fibers. The tongue, lips, nose, earlobes, conjunctivae, and fingertips especially demonstrate this coloration. About 65% of postmenopausal women have hot flushes for 1 to 5 years, 26% for 6 to 10 years, and 10% for more than 11 years.


The anterior hypothalamus has estrogen and progesterone receptors, and both hormones can be used effectively to treat hot flushes through binding with their respective hypothalamic receptors.
This abnormality is probably related to a deficiency of an isoenzyme of liver aldehyde dehydrogenase. Patients should be encouraged to look beyond MSG at other dietary agents, such as red pepper, other spices, nitrites and sulfites (additives in many foods), thermally hot foods and beverages, and alcohol.5 Scombroid fish poisoning (tuna and mackerel) is caused by the ingestion of fish that was left in a warm temperature for hours.
Forty percent to 50% of patients with carcinoids of the small intestine or proximal colon have manifestations of the carcinoid syndrome.10 Tumors that secrete their hormonal product into the portal venous system do not cause flushing, because the released amines are inactivated by the liver.
Foregut carcinoids do not generally secrete serotonin but, instead, its precursor, 5-hydroxytryptamine. Antihistamines remain the preferred treatment for most patients with uncomplicated urticaria pigmentosa. Occurring in one third of the patients with diarrhea, there is pronounced episodic flushing, which, as in the carcinoid syndrome, may be induced by alcohol ingestion.
Most often, hot flushes are only mildly bothersome and can be tolerated without the need for treatment. Pallor is typically present during the attack, and mild flushing may occur after the attack as a rebound vasodilation of the facial cutaneous blood vessels.5 Facial flushing and headache can happen along with sweating of the face, neck, and upper trunk in patients with spinal cord lesions above T6. Important information can be obtained from a 2-week diary in which the patient records qualitative and quantitative aspects of the flushing event and lists exposure to all exogenous agents.2 When the diagnosis remains obscure after evaluation of the 2-week diary, the patient is given an exclusion diet listing foods high in histamine, foods and drugs that affect urinary 5-HIAA tests, and foods and beverages that cause flushing.
The urticarial rash can be isolated or many, sometimes they join together and form a large area of raised, red rash. The thick or wart-like lupus lesions are also known as hypertropic or verrucous discoid lesions. Although it might develop at any age, in most cases, this health disorder is diagnosed between fifteen and forty years of age. Occasionally, the Epstein-Barr virus reactivates to produce common symptoms of viral infections.
The antibodies present in the body attach themselves to the proteins, triggering an inflammatory response. Lupus patients should opt for sunscreen products that feature both the SPF number as well as a star system that indicates the ultraviolet A protection level.
Sunscreens containing zinc oxide and titanium dioxide are most suitable for lupus patients. Again, those allergies have a variety of causes, and bring on similar rashes and other symptoms of dermatitis. It tends to develop on the sun exposed areas in hypersensitive people and resolves spontaneously within minutes and hours after moving away from the sunlight.
In solar urticaria, it appears to be an antigen-antibody complex that triggers the reaction. When an antigen-antibody complex is formed, it triggers the immune system to act and release chemicals and cells which are responsible for inflammation.
One type of immune cells that responds to this complex is a mast cell which is distributed throughout the body. This leads to typical symptoms like itching with swelling and redness, as is seen in urticaria.
If the swelling of the skin is very severe, there may be other systemic symptoms like lightheadedness. Sunlight may be able to penetrate light clothing and cause solar urticaria even on covered areas of the body. These fibers are found in somatic nerves supplying the affected skin, including the trigeminal nerve.
Erythremia results when there is a combination of increased amounts of saturated and desaturated hemoglobin.
There is considerable variation in the frequency, intensity, and duration of hot flushes within and among individuals. Neurotransmitters that may be involved in the pathogenesis of hot flushes include norepinephrine and other noradrenergic substances. This population can be detected by using an ethanol patch test, which produces localized erythema.
In addition to flushing, patients with scombroid fish poisoning experience sweating, vomiting, and diarrhea. Tumors of the foregut (stomach, lung, pancreas) are associated with a bright red geographic flush of a more sustained duration, as well as lacrimation, wheezing, sweating, and a sensation of burning. Screening should therefore seek this product if the other metabolites are not elevated.9 Other mediators that have been proposed include prostaglandins and tachykinins.
Although the levels of serotonin in patients with tumors usually far exceed those found after food ingestion, this precaution helps exclude carcinoid in individuals with borderline high 5-HIAA levels.9 Measuring the blood serotonin level is helpful when the urinary 5-HIAA level is equivocal.
Alpha-interferon causes symptomatic relief accompanied by lowering of the urinary 5-HIAA level. Mast cells contain the enzyme histidine decarboxylase, which enables them to synthesize and store histamine. Human skin blood vessels possess H1 and H2 receptors, which are involved in both vasodilation and increased vascular permeability evoked by histamine. This may occur as an exaggerated response to bowel or bladder distention.1 Other causes are certain pancreatic tumors, insulinoma, and POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal proteinemia, and skin changes). If the flushing reactions completely disappear, restoring the excluded items individually can identify the causative agent. It is advisable to use sun protection even in the night, as artificial sources of light such as halogen or fluorescent lights might trigger skin rash. However, the areas of the body that are usually exposed to sun on a daily basis, like the face and arms, are often spared. Although urticaria is primarily a skin condition, it can affect any tissue in the body like the airways.
The photoallergen in solar urticaria may be chemicals within the body that are altered by sunlight. Solar urticaria is a very uncommon condition accounting for less than 5% of all photodermatoses.
Sunlight should not be considered as a light source during phototesting for solar urticaria. Because autonomic nerve fibers also supply eccrine sweat glands, neurally activated flushing is frequently associated with sweating (wet flushing) as opposed to flushing caused by circulating vasodilator mediators, which frequently does not involve sweating (dry flushing). The central noradrenergic system in the hypothalamus triggers the hot flushes via α2-adrenergic receptors on the noradrenergic neurons. A special type of alcohol flush is also associated with chlorpropamide, the oral antihyperglycemic agent. These symptoms are caused by intoxication with histamine, which is believed to be generated by histidine decarboxylation by bacteria in spoiled fish.
In ileal tumors, the flush is patchier and more violaceous, intermingled with areas of pallor, and does not last as long. Urinary excretion of this substance and its major metabolites can be elevated severalfold in patients with mastocytoses. It typically begins at 2 to 6 months of age when solid foods, mostly fruit, are introduced.
Small doses of diethylstilbestrol are effective in relieving hot flushes but cause gynecomastia. Solar urticaria should not be confused with sunburn as it is an immune-mediated reaction and not due to UV radiation damage. It is also believed that sometimes the use of certain drugs may cause the development of photoallergens. The presence or absence of sweating has therefore been proposed as a clinical guide to the mechanisms of flushing, although in practice this is not always reliable. Flushing of either type may be associated with facial edema, which may persist and lead to telangiectasia and even facial rosacea. Measurement of serotonin and its metabolites permits the detection of 84% of neuroendocrine tumors. Somatostatin is a potent antagonist of the flushing reaction associated with both gastric and ileal carcinoid tumors but has a short half-life.
Oral administration of the mast cell stabilizing agent disodium cromoglycate has proved effective in some patients. Occurring within a few seconds of eating, it has a peculiar distribution in a triangular area that extends from the tragus of the ear to the midpoint of the cheek. This flushing is not associated with sweating but, in some cases, tachycardia, tachypnea, and hypotension may be seen. With extensive disease, pellagra-like skin lesions can also be seen; these result from excessive uptake of tryptophan by the carcinoid tumor, leaving little for the daily niacin requirement. Even carcinoids that predominantly secrete 5-hydroxytryptophan are associated with increased urinary excretion of 5-HIAA because the released 5-hydroxytryptophan is converted to serotonin in other tissues and is subsequently metabolized to 5-HIAA.9 Chromogranin A, a peptide cosecreted with serotonin, is elevated in most patients with carcinoid tumors.
The somatostatin analogue octreotide has a much longer half-life, making subcutaneous therapy possible. The drug does not decrease urinary excretion of histamine and the histamine metabolite MIAA.
The flush is mediated by elevated acetaldehyde plasma levels and possibly by the release of prostaglandins.
These lesions include hyperkeratosis, xerosis, scaling of the legs, forearms, and trunk, angular cheilitis, and glossitis (Fig. In the evaluation of flushing with an equivocal 24-hour urinary 5-HIAA level, a normal plasma chromogranin A value suggests nonendocrine causes.
In patients with systemic symptoms, bone marrow biopsy and liver and spleen scans are usually performed.
Some experts have recommended using this agent only in patients with systemic mastocytosis who suffer from gastrointestinal symptoms. Alcohol ingestion can also trigger flushing in those with carcinoid tumors, mastocytosis, medullary thyroid carcinoma, and certain lymphoid tumors. This test is sensitive but not specific, and its predictive value in carcinoid is still uncertain.10 Flushing was associated with a rise in circulating substance P in 80% of patients with gastric carcinoid.
In adults, gustatory sweating is the predominant feature of auriculotemporal nerve syndrome; flushing happens less often.
Seventy percent of patients also have watery diarrhea, and 35% develop right-sided endocardial fibrosis, leading to congestive heart failure. One half of pediatric patients with this symptom were delivered with forceps assistance, which possibly causes trauma to the nerve.
The likely mechanism is misdirection of parasympathetic fibers along sympathetic pathways during the nerve regeneration that follows trauma. The emergence of symptoms several months after the proposed trauma (usually 3-6 months) is probably related to the time required for nerve regeneration, and it is possible that vigorous chewing causes intense stimulation of the parotid gland.



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