Identifying, classifying and managing chronic urticaria

Urticarial skin diseases are more common in women. Urticaria and angioedema coexist in up to 50% of patients, with urticaria occurring in 40% and angioedema in 10%. A wheal is an itchy, well-circumscribed swelling, often pale in the centre, surrounded by an erythematous flare. It evolves into a pink superficial plaque that resolves slowly and completely. It usually lasts for less than one day but new lesions may appear at other sites. There is great variation in size, shape and numbers. Angioedema is a deeper swelling of the dermis and subcutaneous or submucosal tissue involving the face and mouth but it may occur anywhere on the skin. The lesions are skin-coloured or red and may be painful rather than pruritic. They take longer to resolve.