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Pathophysiological insights into delayed pressure urticaria: A comprehensive review
Kanokvalai Kulthanan1, Yanisorn Nanchaipruek1, Kanyalak Munprom1
1Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Asian Pacific Journal of Allergy and Immunology
|November 3, 2025
Summary
Delayed pressure urticaria (DPU) causes painful swelling hours after pressure. Understanding its complex mechanisms is key to developing new treatments for this chronic condition.
Area of Science:
- Immunology
- Dermatology
Background:
- Delayed pressure urticaria (DPU) is a chronic inducible urticaria subtype.
- Characterized by painful swelling triggered by sustained mechanical pressure, with delayed onset (4-6 hours) and prolonged duration (8 hours to 3 days).
- Associated symptoms like malaise and fatigue affect over half of patients.
Purpose of the Study:
- To review the pathogenesis, histopathology, and inflammatory mechanisms of DPU.
- To highlight diagnostic tools and current treatment challenges.
- To identify unmet clinical needs for developing targeted therapies.
Main Methods:
- Review of existing literature on DPU pathogenesis and clinical presentation.
- Discussion of diagnostic methods including provocation testing (dermographic tester, weighted rod).
- Analysis of implicated inflammatory cells, mediators, and molecules.
Main Results:
- DPU pathogenesis involves mast cell activation, histamine release, eosinophil infiltration, and multiple mediators.
- These factors interact synergistically, leading to clinical symptoms.
- Current diagnostic tools offer reproducibility and threshold determination.
Conclusions:
- A comprehensive understanding of DPU's complex pathophysiology is essential.
- This knowledge may lead to novel immunomodulators and biological therapies.
- Improved treatments are needed for severe and refractory DPU cases.
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