Two cases of yellow urticaria revealing acute lithiasic biliary disease

Abstract

Walsh et al., who described it as an acanthoma with features of porokeratosis, predominantly in men, on their extremeties. 1 It is clinically described as either solitary or multiple hyperkeratotic plaques (often verrucous) or a nodule with mild pruritus. Absence of a central area of epidermal atrophy is a clinically important feature in distinguishing porokeratoma from porokeratosis. 2 Porokeratoma is characterised by prominent multiple and confluent cornoid lamellae throughout the lesion in histopathological examination, whereas the cornoid lamellae is only located at the periphery in classical porokeratosis. 1 The cause of porokeratoma has not been elucidated in which no family history of porokeratoma has been reported as yet. Although dermal amyloid deposits have been observed in several cases of porokeratosis, this is the first report of it occurring in porokeratoma. The causal link between the porokeratosis and the amyloidosis remains unclear. 3 Possible treatments could include complete excision of the lesion, cryotherapy, laser or oral acitretin. 2 It has been reported that porokeratotic cases can have malignant potential, particularly in chronic large lesions. 2 Regular monitoring and follow-up is therefore recommended.

A Case of Yellow Urticaria Associated with Chronic Hepatitis B Infection, Cirrhosis, and Antiviral Treatment

“…Ürtikeryal plaklar saatler içinde kaybolmasına rağmen elastinin bilirubine yüksek afinitesi nedeniyle vücuttaki sarı renk değişikliği ve sarı maküller birkaç gün devam edebilir. 4,8,9 Literatürde kronik karaciğer hastalığı (hemokromatozis, kolon ve meme kanserinin karaciğere metastazı, alkol ilişkili hepatik siroz, viral hepatit), akut karaciğer yetmezliği, biliyer hastalıklar, transfüzyon ve antiviral tedaviler ile ilişkili serumda hiperbilirubinemi oluşturan sarı ürtiker vakalarının ortaya çıktığı belirtilmiştir. 1,2,3,7,10 Hastamız da dört yıldır hepatit B'ye bağlı takipliydi ve entekavir tedavisi alıyordu.…”

“…İlk olarak 1969'da Clarke tarafından tanımlanan bu nadir ürtiker formu "sarı ürtiker" olarak belirtilmiştir. [1][2][3][4][5] Bu olguda hepatit B enfeksiyonuna bağlı karaciğer sirozu tanısıyla takipli ve antiviral tedavi alan, sarı ürtikeryal plak ve papülleri ortaya çıkan bir hasta sunulmuştur. Serumda hiperbilirubineminin eşlik ettiği ürtikerli hastalarda vücutta sarı ürtikeryal makül, papül ve plakların görülebileceğinin farkında olunması amaçlanmıştır.…”

Yellow Urticaria

“…Yellow urticaria has been reported in the setting of hepatitis, cirrhosis, acute liver failure, choledocholithiasis, antiretroviral therapy, 2 and metastatic disease to the liver. 3,4 Treatment with antihistamines is effective for relieving pruritus and edema. A yellow color may remain after the resolution of urticaria and hyperbilirubinemia because of the affinity of bilirubin for elastin.…”

“…A yellow color may remain after the resolution of urticaria and hyperbilirubinemia because of the affinity of bilirubin for elastin. 4…”

“…Disease states that lead to hyperbilirubinemia should be ruled out in patients presenting with YU. Yellow urticaria has been reported in the setting of hepatitis, cirrhosis, acute liver failure, choledocholithiasis, antiretroviral therapy, and metastatic disease to the liver . Treatment with antihistamines is effective for relieving pruritus and edema.…”