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[The disease under chronic urticaria: beyond itching]
Lucía Moreno-Lozano1, Teresa De Aramburu-Mera2, Carmen Bermúdez-Hormigo2
1Servicio de Alergología, Hospital Punta Europa, Algeciras-Cádiz-España. luciamoreloza@gmail.com.
Revista Alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)
|April 29, 2024
Summary
Diagnosing chronic urticaria requires careful evaluation, as symptoms may indicate dermatitis herpetiformis. Prompt diagnosis and a gluten-free diet with dapsone treatment led to satisfactory results in a lymphoma patient.
Area of Science:
- Dermatology
- Immunology
- Oncology
Background:
- Distinguishing urticaria from other dermatoses like dermatitis herpetiformis is crucial for accurate diagnosis.
- Persistent erythematous-papular rashes necessitate comprehensive diagnostic workup beyond initial assessments.
Observation:
- A 53-year-old female with a history of diffuse large B cell lymphoma presented with chronic, unresponsive erythematous-papular skin lesions.
- Previous treatments including antihistamines, corticosteroids, and omalizumab yielded no improvement.
- Positive antinuclear antibody (ANA) and specific HLA markers (DQ2 and DQ2.5) were noted.
Findings:
- Skin biopsy confirmed dermatitis herpetiformis, a condition often associated with celiac disease.
- Genetic testing revealed heterozygosity for HLA-DQ2 and HLA-DQ2.5.
- Treatment with a gluten-free diet and dapsone resulted in significant clinical improvement.
Implications:
- This case highlights the importance of considering dermatitis herpetiformis in refractory urticaria cases, especially in patients with autoimmune markers.
- A multidisciplinary approach is essential for accurate diagnosis and management of complex dermatological conditions.
- Careful monitoring is advised due to potential side effects associated with dapsone therapy.
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