The Agony of the Chronic Itch: A Case Study of Chronic Urticaria Dermographism

Friday, 24 July 2015: 1:50 PM

Susan C. Davidson, EdD, MSN, APRN, NP-C
School of Nursing, University of TN at Chattanooga, Chattanooga, TN
Robyn B. Tobias, MSN, BSN, APRN, NP-C
School of Nursing Dept 1051, University of TN at Chattanooga, Chattanooga, TN


            Urticaria is a common skin condition characterized by the sudden appearance of pruritic, erythematous areas on the skin that may also include superficial swelling of the dermis and possibly angioedema (Saini, 2014). Urticaria is commonly known as hives and when chronic, can have a significant impact on a persons’ life. The condition is termed chronic when the hives appear either continuously or intermittently for a period of at least 6 weeks and with no identifiable cause. The duration of the hives can last from a few minutes to several hours. Therefore, many practitioners view urticaria not as a disease but a pattern of reactions that result in wheals, hives and intense itching.

Dermographism is a type of urticaria characterized by irregularly shaped wheals that develop at sites of scratching, pressure or friction with the lesions typically resolving in about an hour. When the urticaria is idiopathic, it can be frustrating to both the patient and the practitioner. Although much has been published from a medical perspective, few articles have presented case studies and treatment by nurse practitioners (NPs). The purpose of this case study is to describe the subtle onset of symptoms for no apparent reason, in a middle aged woman. It is hoped that this case study will increase awareness among nurse practitioners of this condition, its clinical manifestations, diagnostic work-up, and management strategies for nurse practitioners in primary care settings.

Nurse practitioners need to be knowledgeable about how to diagnose and manage patients with chronic urticaria. As there is no one theory for how this condition occurs, NPs need to stay up to date on this clinical entity and use best practices in managing their patients care. NPs should be prepared to try a variety of treatment approaches and establish collaboration with a multi-disciplinary team in order to ensure the most effective and successful outcome of the patient with chronic urticaria.