Skin nontumor
Dermal perivascular and vasculopathic reaction patterns
Urticaria (hives)

Topic Completed: 1 August 2011

Minor changes: 22 July 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Urticaria [title] skin

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Urticaria (hives). website. Accessed August 11th, 2020.
Definition / general
  • Pruritic, edematous plaques (wheals) due to localized mast cell degranulation and dermal microvascular hyperpermeability
  • Individual lesions fade within 24 hours, although episodes may last days to months
  • Commonly at pressure points
  • Causes: collagen vascular disorders, Hodgkin lymphoma, allergies (mediated by IgE, bridging by multivalent ligand), IgE independent allergies (contrast dye, opiates, aspirin [suppresses prostaglandins]), hereditary angioedema (deficiency of C1 esterase inhibitor causes uncontrolled complement component activation), infections, heat, cold, pressure, vibration
  • Angioedema: like urticaria, but in deep dermis / subcutaneous fat
  • Ages 20 - 40 years are most common
Clinical images

Contributed by Mark R. Wick, M.D.

Breast skin

Microscopic (histologic) description
  • Age of the lesion biopsied and nature of evoking stimulus may influence type and intensity of inflammatory response
  • Subtle edema (widely spaced collagen bundles), mild eosinophilic infiltrate and dilated lymphatics
  • Also dilatation of small blood vessels and lymphatics, often endothelial swelling
  • Cellular infiltrate is usually mild, perivascular, lymphocytes and a few eosinophils, occasional interstitial eosinophils
  • No vasculitis
  • Neutrophils often noted in early lesions, but relatively sparse; may be more prominent in physical urticarias
  • Transmigration of neutrophils through vessel walls may resemble vasculitis, but no fibrinoid change, hemorrhage or leukocytoclasis
  • In papular urticaria, inflammation is heavier than in other chronic urticarias, consists of superficial and deep perivascular lymphocytes and eosinophils
Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.

Breast skin

Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.

Dilated lymphatics

Perivascular inflammation

Scattered interstitial eosinophils

Electron microscopy description
  • Platelets and other cells in lumen of mildly dilated vessels in upper dermis
  • Lymphocytes and dendritic cells are close to the vessels
  • Mast cells may be normal or degranulated
Additional references
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