Angioedema, vibratory T78.3; D84.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Rare edema formation occurring after repetitive (vibratory) shocks to the skin, limited to the site of action, usually painful or burning or itching.

Etiopathogenesis
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Often autosomal dominant inheritance mechanism. Sporadic cases also known.

Clinical features
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After vibratory trauma (working with percussion drills, motor mowers, jogging), first redness appears at the site of exposure, followed by an itchy or painful swelling. Maximum of symptoms a few hours after exposure, after 24 hours skin condition returns to normal.

Histology
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Edema of the deep dermis and subcutis. Interstitial and periadnexual infiltrate of eosinophilic and neutrophilic leukocytes, T-lymphocytes and monocytes. Detection of proinflammatory cytokines such as TNF-alpha, IL-3, IL-6 as well as the expression of adhesion molecules (VCAM-1, ICAM-1) in the vessel walls.

Therapy
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Avoid triggering mechanisms as far as possible. The only effective therapy is the administration of systemic glucocorticoids such as prednisolone (e.g. Decortin H) initially 50-80 mg/day, with the lowest possible maintenance dose. Antihistamines are generally ineffective.

Literature
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  1. Cap JP et al (1985) The effect of ketotifen in Urticaria factitia and Urticaria cholinergica in a crossed double-blind experiment. Dermatologist 36: 509-511
  2. Butcher M, grave J (2004) Pyhsikalische Urtikaria. dermatologist 55: 344-349
  3. Kontou-Fili K et al (1997) Physical urticaria:classification and diagnostic guidelines. Allergy 552: 504-513

Outgoing links (1)

Cytokines;

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Last updated on: 29.10.2020