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Jazmina Mba Gonzalez, Robert F. Centeno, Facial Aesthetic Surgery in the Setting of Localized Heat-Induced Urticaria, Aesthetic Surgery Journal, Volume 34, Issue 7, September 2014, Pages NP61–NP65, https://doi.org/10.1177/1090820X14539974
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Localized heat-induced urticaria is a physical urticaria resulting in an eruption of itchy wheals, angioedema, or both when exposed to heated material.1 Diagnosis usually is clinical, and a heat challenge test is necessary to distinguish localized heat urticaria from other similar forms of chronic urticaria such as dermatographic urticaria or delayed-pressure urticaria. The heat challenge test is performed by applying a heated object to the skin or by submerging the patient’s hands in warmed water until an urticarial response is observed. A positive test would present with pruritus and wheals typically appearing within minutes and lasting up to 2 hours after stimulus.2 In contrast, dermatographic urticaria is characterized by the presence of marked erythema and wheals by mechanical irritation (ie, a scratch), irrespective of the temperature of the trigger.3 Similarly, in delayed-pressure urticaria, a patient would display a reaction upon sustained-pressure application on the skin, with wheals appearing on average 6 hours after pressure is applied and lasting up to 72 hours in severe cases.4 Severe urticarial cases may be associated with systemic reaction and occasionally progress to anaphylaxis.1 These patients exhibit flushing, nausea, diarrhea, dizziness, and syncopal episodes when exposed to either physical or mechanical triggers.5,6 There have been only approximately 53 cases of heat-induced urticaria reported worldwide since its initial description in 1924,3 although it is thought that many cases go undiagnosed. Ingestion of hot beverages or meals, prolonged exposure to hot water, and even warmed objects have been described as triggers.7,8 The etiology remains unclear, but factors such as local release of histamine,8 activation of the complement pathway,9 or prostaglandin D2 release have been suggested.10 There is no sole management for localized heat-induced urticaria since chronic urticarias have varying degrees of response to treatment. Medically oriented options include nonsedative antihistamines as a first-line pharmacologic agent for patients in whom chronic urticarias cause significant lifestyle change. Not all patients may respond to treatment, and some may worsen. Secondary medications include antileukotrienes, corticosteroids, or immunomodulating therapies. Alternatively, avoidance of stimuli is another method of managing chronic urticaria for those patients who can cope with mild lifestyle changes.1
