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Severe itching in armpit and groin area, diagnosed with pressure dermatitis and heat production, prescribed steroidal cream. Advise?

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my Dermatologist says that the severe itching i suffer with in my arm pits and groin are due to heat production and
Pressure Dermatitis. could you explain the physiology of this mecdhanism? many thanks, He has prescribed some non steroidal cream that has a potent
antihistamine effect [ name unknown].. he says that this could also be related to a possible drug allergy
10/30/2011 XXXXXXX XXXXXXX dyer,md [retired] [age 85]
Posted Wed, 2 May 2012 in Skin Hair and Nails
Answered by Dr. Yogesh D 22 minutes later

Thank you for posting your query.

At the outset I would like to apologize for a delayed response.

I presume your dermatologist meant pressure urticaria when he said pressure dermatitis.

Pressure urticaria is an uncommon form of physical urticaria. Pressure urticaria may occur immediately (within minutes) after a pressure stimulus ; however, more commonly, pressure urticaria develops after a delay of 4-6 hours after a pressure stimulus; hence, the designation delayed pressure urticaria (DPU) is used. The wheals may last for 8-72 hours. The hands, feet, trunk, buttocks, legs, and face are the most common areas affected. Lesions can be induced by a variety of stimuli, including standing, walking, wearing of tight clothes, or sitting on a hard surface, rarely by heat.

The pathogenesis of delayed pressure urticaria is unknown. No allergen can usually be identified.
Mast cells and histamine release are believed to play roles because, the injection of compound 48/80, which causes depletion of mast cell mediators, prevents the induction of lesions in the injected area.
Histamine levels are increased in lesional skin, and intracellular histamine levels are decreased in peripheral white blood cells.
Despite these findings and the finding of increased stimulated histamine release, histamine is not likely to be the sole mediator in pressure urticaria, given the relative unresponsiveness of the condition to antihistamine treatment.
Other possible mediators include eosinophils, given the elevated numbers of eosinophils, eosinophil cationic protein (ECP), and eosinophil cationic factor (ECF) found in biopsy specimens from some patients with delayed pressure urticaria, particularly bullous delayed pressure urticaria.
Elevated concentrations of interleukins 5 and 6 and leukotrienes have also been found in lesional skin of pressure urticaria patients.

Dapsone is known to be very effective in treating this condition when the usual anti-histamines and others fail. You can discuss this with your dermatologist.

Hope I have answered your query. Do write back to me if your have further queries.

Wishing you a speedy recovery.


Dr. Yogesh. D
Above answer was peer-reviewed by
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