Urticaria clinically presents as circumscribed, raised, edematous, usually pruritic evanescent skin lesions. The lesions may be pink or red, although classically they are pale wheals surrounded by an erythematous flare. The individual lesions of urticaria arise suddenly, rarely persist for more than 24 hours, and may continue to recur for an indefinite period. These lesions usually are discrete, round or oval in shape; less commonly they may be irregular, serpiginous, or gyrate. Urticarial wheals are variable in size ranging from a few millimetres to lesions involving whole extremity. Lesions may appear anywhere on the body including scalp, palms and soles. In 40- 50% of cases urticaria is associated with angioedema. Wheals usually resolve within 24 hours passing through a macular erythematous phase, but nearly always leaving the skin with a normal appearance. Urticarial wheals are very itchy and patients tend to rub rather than scratch, hence excoriation marks are not seen [1-4].

There is scarce information on the Urticaria activity score and involvements of body sites among patients sufferingfromChronic Spontaneous Urticaria in Himachal Pradesh. Therefore present study was done to evaluate theUrticaria activity score and involvements of body sites among patients with Chronic Spontaneous Urticaria.       

Aims and Objectives

To evaluate theUrticaria activity score and involvements of body sites among patients with Chronic Spontaneous Urticaria.

• Research Approach: Descriptive

• Research Design: Hospital based Cross-sectional survey desig

• Study Area: OPD of Dermatology, Venereology and Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh

• Study Duration- between April 2016 and March 2017

• Study Population: Patients of Chronic Spontaneous Urticaria

• Sample Size: All 100 consecutive patients of chronic Spontaneousurticaria aged 18 years and above attending the outpatient Dermatology, Venereology & Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh between April 2016 and March 2017 were enrolled for the study

• Inclusive Criteria- who were willing to participate in the study

Exclusion Criteria

• Patients suffering from physical urticaria, urticarial vasculitis, or acute urticaria

• Patients younger than 18 years of age

• Pregnant and lactating women

• Patients taking medications that can influence the coagulation/fibrinolysis pathway (asprin, clopidogrel, warfarin, heparin)

• Study Tool: A self-designed, close ended questionnaires consisting of socio-demography, symptoms, duration, previous medical history etc. was created

• Validity of Tool: By the experts in this field

• Data Collection: Data was collected under the guidance of supervisors. The demographic profile, age, sex, occupation, place of residence, duration and evolution of urticaria, personal and family history, detailed medical history and clinical details of urticaria were recorded on a pre-designed proforma. Physical urticaria was excluded on the basis of thorough clinical history/examination and provocation tests. A clinical examination and investigations were performed to exclude systemic diseases/infections known to cause urticaria. The severity of symptoms and signs of urticaria were graded on the basis of modified urticaria activity score described by Sabore et al. [5], wherein a numerical value is assigned to sign/symptom ignoring the size of the wheal

Urticaria Activity Score (UAS)

Pruritus Severity Score

• Absent = 0 

• Present but not disturbing =1 

• Disturbing but not hampering daytime activity or sleep = 2 

 Hampering day time activity or sleep = 3 

Wheal Score (Average no. of Wheals in 24 Hours) 

• Less than 10 wheals = 1 

• 10-50 wheals = 2 

• >50 wheals = 3 

• Involving almost whole body = 4

• Urticaria activity score = pruritus severity score + wheal score

• Urticaria severity score: Mild =UAS up to 2, Moderate = UAS of 3-5, Severe= UAS of 6-7

The study comprised 100 consecutive patients with chronic Spontaneousurticaria and had 25 males and 75 females (M: F = 1:3) aged between 18 and 69 (Mean±SD = 36.12±10.88) years. Thirty-seven (37%) patients were aged less than or equal to 30 years and 9 patients were more than 50 years of age. The majority, 68 (68%) patients were aged between 18-40 years followed by 23 (23%) patients in the age group of 41-50 years (Table 1).

Mean urticaria activity scores (UAS) among patients was 5.30±1.374. Overall, 72 patients had high urticaria activity score of 5-7 and 28 patients had urticaria activity score of 2-4 (Table 2).

All patients had 2 or more body sites involved. The number of sites involved varied from 2 to 7 among patients with mean involvement of 3.9±1.36 sites. 77 patients had 2-4 body sites affected while 23 patients had 5-7 sites involved (Table 3).

Limbs (96) and trunk (97) were the most frequent affected sites followed by face (64), scalp (62), palms & soles (53) while Mouth and Tongue (5) were the least affected sites. (Table 4)

37 patients had urticaria associated episodic angioedema. The frequency of angioedema varied between 1 and 50 (Mean±SD = 1.54±1.01) episodes per year. Up to 10 episodes of angioedema in a year were reported by 32 patients and comprised the majority (Table 5).

Table 1: Age and Gender Distribution of Patients

Table 2: Urticaria Activity Score

Table 3: Number of Body Sites Involved among Patients

Table 4: Individual Sites Involved by Urticarial Wheals

Table 5: Number of Angioedema Episodes per Year

The present study comprised 100 consecutive patients with chronic Spontaneousurticaria and had 25 males and 75 females (M:F = 1:3) aged between 18 and 69 (Mean±SD = 36.12±10.88) years. Similar to our study, in the study done by Maria Regina CavarianiSilvares et al. [6], chronic urticaria-angioedema occurred mainly in females (mean age: 35 years), but also in men (Mean age: 32 years).

In our study, mean urticaria activity scores (UAS) among patients was 5.30 ±1.374. Overall, 72 patients had high urticaria activity score of 5-7 and 28 patients had urticaria activity score of 2-4. All patients had 2 or more body sites involved. The number of sites involved varied from 2 to 7 among patients with mean involvement of 3.9±1.36 sites. 77 patients had 2-4 body sites affected while 23 patients had 5-7 sites involved. Limbs (96) and trunk (97) were the most frequent affected sites followed by face (64), scalp (62), palms and soles (53) while Mouth and Tongue (5) were the least affected sites. 37 patients had urticaria associated episodic angioedema. The frequency of angioedema varied between 1 and 50 (Mean±SD = 1.54±1.01) episodes per year. Up to 10 episodes of angioedema in a year were reported by 32 patients and comprised the majority. Asero et al. [7], Takahagi et al. [8] Triwongwarant et al. [9] also made similar observations fordisease activity.

This means that most urticarial rashes ‘move’ around the body – a useful pointer from the clinical history that the rash is urticarial. Urticaria is to be distinguished from ‘angioedema’, which is well-demarcated swelling, occurring within deep skin structures or in subcutaneous tissue and caused mainly by bradykinin production. Angioedema is not itchy, but may be painful. In about 50% of patients urticaria occurs alone; in about 40% of patients urticaria occurs with angioedema and in about 10% of patients angioedema occurs alone [10].

Our study concluded that most of the patients of Chronic Spontaneous Urticaria had high urticaria activity score of 5-7. All patients had 2 or more body sites involved and Limbs & trunk were the most frequent affected sites while Mouth & Tongue were the least affected sites. Around one third patients had urticariaassociated episodic angioedema.

Limitations

Small number of patients, lack of treatment outcome measures, and unavailability of specific parameters to determine coagulation pathway activation, and a cross-sectional nature of study are some of the limitations of this study.

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