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Physical urticarias

John P Dice, MD
Erika Gonzalez-Reyes, MD
Section Editors
Sarbjit Saini, MD
Craig A Elmets, MD
Deputy Editor
Anna M Feldweg, MD


Physical urticarias are disorders in which urticaria (ie, hives or wheals) are induced by environmental stimuli, such as heat, cold, pressure applied to the skin, exercise, water, vibration, and sunlight. These conditions probably result from heightened sensitivity by the mast cell to environmental conditions, although the exact pathogenesis is unknown.

An urticarial lesion is an intensely pruritic, circumscribed, raised, erythematous plaque, which can range in diameter from a few millimeters to many centimeters (picture 1 and picture 2). Urticaria may enlarge, sometimes developing central pallor, and coalesce with other adjacent lesions. They usually appear in crops and are typically short-lived, expanding and then resolving over a few hours without leaving residual marks on the skin (unless there is trauma from scratching).

Physical urticarias, except cold urticaria, will be discussed in this topic review. Other disorders of acute and chronic urticaria and cold urticaria are reviewed separately. (See "New-onset urticaria" and "Chronic urticaria: Clinical manifestations, diagnosis, pathogenesis, and natural history" and "Chronic urticaria: Standard management and patient education" and "Cold urticaria".)


Before discussing individual syndromes, it is helpful to review some observations about the physical urticaria disorders as a group.

Physical urticarias are considered subtypes of chronic urticaria. In some patients, a specific physical stimulus is the only trigger for hives, whereas in others, a physical stimulus is an identifiable factor in a case of otherwise idiopathic chronic urticaria (also called chronic spontaneous urticaria). A minority of patients have hives triggered by multiple physical stimuli.

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Literature review current through: Nov 2017. | This topic last updated: Mar 31, 2016.
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