Cholinergic Urticaria??

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Hey guys! I need some help. A friend of mine asked me about a red pinpoint (almost petechial-looking) rash that she gets every time she exercises. I told her to go to the doc. She went, and they said it was cholinergic urticaria. They prescribed a prednisone taper for her. I have some questions about this for some of you who might know more about derm than I do. I AM NOT ASKING FOR MEDICAL ADVICE, just knowledge, k?? So here are a few questions I have for you. First, I have seen hives before, but they have always been itchy, red welts. My friend said hers don't itch, and they are tiny and not raised. Do they sometimes manifest that way? Also, she gets this rash whenever she exercises vigorously (not just walking or anything), and a few times she said they have shown up when she took a shower that was too hot. She has really fair skin and sometimes gets the same kind of thing on her forearm if she is in the sun too long without sunblock. She said the sun thing has been happening consistently for about 5 years, and her dermatologist basically said too bad so sad wear sunblock. But the exercise/heat thing first happened a few years ago, then stopped, and has been back consistently for a few months now. Does that sound like cholinergic urticaria to you? Also, the prednisone makes me wonder, too. I only very briefly talked about this one time in clinical, but I'm sure that my instructor said that steroids are contraindicated, and that they would prescribe claritin for it (this was before claritin was OTC - it's been awhile!). So basically, am I way off with this? Does it sound like that's what it really is? Again, don't want medical advice, just want to know more about typical presentation and usual treatment. For some reason I have a bad feeling about the pred. Thanks to all!

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http://www.emedicine.com/derm/topic442.htm

This is from one of my favorite websites to visit when I have a question about a somewhat obscure condition.

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Specializes in Med/Surg, Ortho.

My kids get a hive like rash with different activities. One gets them when he gets in water, shower, pools, whatever. The other gets them when she runs, she is a cross country runner and they will show up after she has workouts. They both use claritin to calm the rash. Or take it before and it doesnt come up.

We also have a patient that when admitted will tell us she is allergic to water. Same reaction as my son i presume.

Anyway, it is a reaction by the mast cells in the skin. Histamine is released causing the allergic type rash.

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I also suffer from urticaria and it can be itchy as well as embarrasing and spreads with scratching. My doctor just adviced to take Claritin also and it works just fine. My hive usually appear when I'm outside in the heat or go from extreme hot to cold temperatures.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Per TOS, we cannot advise you about your friend's condition. She needs to continue to discuss her problem with her PCP. We hope she finds an answer to her problem.

You've received a good link from EricEnfermero.

Here's a couple more on cholinergic urticaria:

http://www.aaaai.org/aadmc/currentliterature/selectedarticles/2005archive/pathogenesis_urticaria.html

http://dermatology.cdlib.org/103/NYU/case_presentations/031604n5.html

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