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Urticaria pigmentosa is the most common manifestation of cutaneous mastocytosis. Three-quarters of all cases occur during infancy or early childhood. Occasionally, vesicles or bullae may appear in persons with urticaria pigmentosa. We describe an unusual case of bullous urticaria pigmentosa with prominent scalp involvement. Prognosis and therapy are reviewed.
Urticaria pigmentosa, characterized by cutaneous mast cell proliferation, usually occurs sporadically in childhood and resolves over a period. Rarely is the condition seen in two or more members of a family. We encountered a family in which urticaria pigmentosa occurred in four members of two generations. Skin findings were similar in all four. No systemic manifestations other than occasional flushing episodes were noted in any of the affected individuals. HLA typing was performed, but no significant correlation between affected and unaffected individuals was seen. In a review of a number of previously reported cases, we found a slight female preponderance.
Urticaria pigmentosa is a rare dermatologic disorder characterized by cutaneous mastocytosis either in isolated or diffuse forms. The disease usually occurs before age 4, but does occur in adulthood. When it occurs in adults, it is associated with a higher incidence of systemic involvement and malignancy. We describe a case of reactivated urticaria pigmentosa temporally associated with acute contact dermatitis in an adult. We describe a practical screening method for systemic involvement and an approach to treatment.
Urticaria pigmentosa is a usually a benign and asymptomatic cutaneous variant of mastocytosis, which is a relatively rare disorder characterized by abnormal aggregates of mast cells in the dermis. These aggregations, if present, can abruptly release vasoactive mediators such as histamine, heparin, and prostaglandins under some physical stresses and may produce flushing, hypotension, syncope, shock, etc. One of the interesting aspects to an anesthesiologist is the effect of drugs administered perioperatively on mast cell degranulation. We report an infant case of urticaria pigmentosa and discuss the anesthetic significance especially of mastocytosis during anesthesia and surgery.
Urticaria pigmentosa is a cutaneous variant of mastocytosis. This is a complex group of diseases distinguished by abnormal aggregation of mast cells within the skin and other organs. Mast cell degranulation and subsequent release of vasoactive amines may occur in response to a variety of non-immune triggers leading to, as its most severe manifestation, a clinical picture of anaphylactic shock. We present the anaesthetic management during labour of a patient with urticaria pigmentosa.
Urticaria pigmentosa (UP), resulting from the accumulation of excessive numbers of mast cells in the skin, is the most common form of cutaneous mastocytosis. Observations highlight the diversity of this disease. Clonal expansion of early hematopoietic progenitor cells carrying activating mutations in KIT seems to be the basis of adult-onset UP. New pathogenetic findings are leading to the development of new diagnostic surrogate markers of disease and therapeutic approaches targeting neoplastic mast cells. Promising strategies may arise from an increased understanding about the cause of mastocytosis and the signaling pathways initiated by kit activation.
Urticaria pigmentosa (UP) is a disorder of mast cell proliferation that occurs in cutaneous tissue. Most patients whose skin manifestations appear in infancy or childhood, experience a resolution of the disease by adolescence. In order to elucidate the relationship between mast cell character and UP prognosis, we used an immunohistochemical approach to examine the expression of stem cell factor (SCF) and c-Kit in the skin of patients with UP. The results revealed intercellular SCF expression throughout the dermis in improving cases. On the other hand, in cases with a tendency to worsen, dermal SCF was recognized only partially or not at all. Regardless of the clinical course, intracellular SCF immunoreactivity of the entire epidermis increased in cases of child onset UP. The c-Kit expression of mast cells in all UP patients showed no relation to clinical features. These findings suggest that SCF in the dermis promotes the differentiation of mast cells infiltrating in UP, and might be an attractive candidate to induce the remission of UP.
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We describe urticaria pigmentosa in three generations of a kindred. Unique to this family is the marked diversity of their skin disease. Classic lesions of urticaria pigmentosa, telangiectasia macularis eruptiva perstans, and clinically normal skin with positive dermal infiltrates of excess mast cells were found in individual family members. Urticaria pigmentosa is rarely reported as an inherited disease. To our knowledge, this is the largest American kindred of familial mast cell disease and is the second report documenting disease in three generations.
We have quantified perivascular mast cells in cases of urticaria pigmentosa, urticaria, and dermal hypersensitivity reactions. To facilitate reproducibility, the mast cells were counted for a precisely defined vessel unit. These vessel units were divided arbitrarily into those < or = 55 microns and > 55 microns in largest diameters. Urticaria pigmentosa showed an average of 6.4 +/- 1.9 and 22.8 +/- 13.2 mast cells for vessel unit < or = 55 microns and > 55 microns, respectively. Urticaria yielded a lower number of mast cells: 1.5 +/- 0.2 and 2.9 +/- 0.9 for the same respective vessel units. Dermal hypersensitivity reactions revealed an average of 1.6 +/- 0.4 and 2.2 +/- 0.7 mast cells, and the normal skin showed 1.5 +/- 0.3 and 2.4 +/- 0.6 mast cells for each of the vessel units of < or = 55 microns and > 55 microns. The perivascular mast cell distributions of urticaria pigmentosa are statistically different from those of urticaria and dermal hypersensitivity reactions with p < 0.0001. No statistical difference was noted between urticaria, dermal hypersensitivity reactions, and normal skin. The percentages of vessel units < or = 55 microns with > or = 5 mast cells and vessel units > 55 microns with > or = 10 mast cells were determined for each case. The average percentage of vessel units for the former and latter in urticaria pigmentosa was 82.6% and 58.9%, respectively. Urticaria yielded 0% and 0.2%, respectively. None of vessel units in the dermal hypersensitivity reactions or normal skin contained more than 5 mast cells in vessel units < or = 55 microns and more than 10 mast cells in vessel units > 55 microns. Cases of urticaria pigmentosa can be distinguished from other cutaneous eruptions containing mast cells using a simple counting technique on Giemsa stained sections.
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Urticaria pigmentosa is the most common manifestation of mastocytosis, with the majority of cases undergoing spontaneous resolution, especially in children. Several reports have documented hematologic malignancies developing in patients with urticaria pigmentosa. We present a 4.5-year-old boy with urticaria pigmentosa who developed Wilms tumor. To our knowledge, coexisting urticaria pigmentosa and Wilms tumor have not previously been described.
Patients with urticaria pigmentosa were investigated during symptom-free interval regarding plasma concentrations and urinary excretion of immunoreactive regulatory peptides: calcitonin gene-related peptide (CGRP), gastrin, neurokinin A (NKA), neuropeptide Y (NPY), somatostatin (SOM), substance P (SP) and vasoactive intestinal peptide (VIP). The plasma concentrations of these peptides, except for CGRP, were below the detection limit. The urinary excretion of the regulatory peptides were not higher in the patient group than in the controls, but in individual patients there was high urinary excretion of SP and VIP. A lower urinary excretion of CGRP was found in the patient group in addition to a tendency to a lower plasma concentration.
Urticaria pigmentosa is the most common form of mastocytosis, a disease in which abnormal proliferations of mast cells occur in various organs of the body. Multiple stimuli, including many drugs commonly used in anesthetic practice, can provoke mast cell degranulation and result in intraoperative hemodynamic instability. An anesthetic plan minimizing histamine release and utilizing vecuronium as the muscle relaxant is discussed, and the literature pertaining to urticaria pigmentosa is reviewed.
A patient with urticaria pigmentosa who gave a 40-year history of diarrhoea was found to have systemic mastocytosis with gut involvement. The radiological appearance of the gut in this disease, although not widely recognized, are specific and should be looked for carefully in patients with urticaria pigmentosa who complain of gastro-intestinal symptoms. Gastro-intestinal symptoms, due mainly to alterations in bowel motility or peptic ulceration, are said to occur in some 25-50% of cases of systemic mastocytosis (3, 6). These symptoms have usually been ascribed to generalized histamine release acting on the gut, although cases where mast cell infiltration of the bowel has occurred have also been reported (4, 5). In a review of the radiological features (2), increased gastric rugosity with or without evidence of peptic ulceration and nodular space-filling defects of the bowel mucosa were the most commonly found. Occasionally, diffuse thickening of the bowel wall was seen. It was concluded that these appearance were probably due to local release of vasoactive substances causing submucosal oedema following mast cell accumulation in the gut. Another result of such infiltration may be malabsorption (1).
Childhood urticaria pigmentosa is generally considered to have a good prognosis with the majority of cases undergoing spontaneous resolution. However, there have been a number of reports of haematological malignancies occurring in association with urticaria pigmentosa. We describe a child with extensive urticaria pigmentosa and a congenital cardiac anomaly who developed acute lymphoblastic leukaemia and suggest a possible common aetiology.
Thirty-three patients with histologically verified urticaria pigmentosa were studied for coexisting atopic disease by means of history, skin prick testing with five common inhalants and serological investigation for total IgE and specific IgE antibodies to five common inhalants. The prevalence of atopy in urticaria pigmentosa was similar to that observed in the normal Swiss population, both on the basis of history (7/33 = 21%) and of positive skin prick tests to common inhalants (12/33 = 36%). However, total serum IgE levels were significantly lower (geometric mean value 16.8 kU/l) than in a control group of 52 Swiss blood donors of comparable age and sex distribution (geometric mean value 43.0 kU/l, t = 2.93, P less than 0.005). Specific IgE antibodies to common inhalants were also observed less frequently in urticaria pigmentosa patients than in controls, although this difference was not statistically significant. Low total and specific IgE values in patients with urticaria pigmentosa may be explained by increased absorption of circulating IgE to abundant tissue mast cells.