TOC and Sample Chapters - McGraw-Hill Professional
TOC and Sample Chapters - McGraw-Hill Professional
TOC and Sample Chapters - McGraw-Hill Professional
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306 Part II Dermatology <strong>and</strong> Internal Medicine<br />
Figure 14-5. Macular amyloidosis Gray-brown, reticulated pigmentation on the back of a 56-year-old Arab.<br />
Urticaria <strong>and</strong> Angioedema<br />
ICD-9: 708.0 ° ICD-10: L50<br />
■ Urticaria is composed of wheals (transient<br />
edematous papules <strong>and</strong> plaques, usually pruritic<br />
<strong>and</strong> due to edema of the papillary body) (Fig. 14-6;<br />
also see Fig. 14-8). The wheals are superficial,<br />
well defined.<br />
■ Angioedema is a larger edematous area that<br />
involves the dermis <strong>and</strong> subcutaneous tissue<br />
(Fig. 14-7) <strong>and</strong> is deep <strong>and</strong> ill defined. Urticaria<br />
<strong>and</strong> angioedema are thus the same edematous<br />
process but involving different levels of the<br />
cutaneous vascular plexus: papillary <strong>and</strong> deep.<br />
■ Urticaria <strong>and</strong>/or angioedema may be acute<br />
recurrent or chronic recurrent.<br />
◐ ➔ ○<br />
■ Other forms of urticaria/angioedema are<br />
recognized: IgE <strong>and</strong> IgE receptor dependent,<br />
physical, contact, mast cell degranulation related,<br />
<strong>and</strong> idiopathic.<br />
■ In addition, angioedema/urticaria can be mediated<br />
by bradykinin, the complement system, <strong>and</strong> other<br />
effector mechanisms.<br />
■ Urticarial vasculitis is a special form of cutaneous<br />
necrotizing venulitis (see p. 363).<br />
■ There are some syndromes with angioedema in<br />
which urticarial wheals are rarely present (e.g.,<br />
hereditary angioedema).
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