Virginia Research Day 2022

Medical Resident Research Case Reports

15 Stress Induced Urticaria

Crystal Downer; Dustin Sorkhpoosh Corresponding author: Crystal.Downer@hcahealthcare.com

LewisGale Hospital- Montgomery Blacksburg Family Medicine

Introduction: Stress induced urticaria is a rare condition involving episodic rashes associated with inciting stressors. This is a recently discovered phenomenon that was first described in 1985 and there are few publications on this topic. Diagnosis is mostly made through careful history and physical examination. While symptomatic treatment can be useful, definitive resolution can only be done through avoidance or treatment of the underlying trigger. Stress induced urticaria is uncommon and it can be easily missed in the clinical setting. The goal of our case study is to illustrate the presentation of stress induced uticaria in the clinic setting and possible treatment approach. Body: We present the case of 19 year old Caucasian female with a history of anxiety presenting with a complaint of intermittent pruritic rash which had worsened despite antibiotics and emollients. On Initial presentation the patient was found to be well dressed, in no acute distress and appeared

advised on initiating psychotherapy. Patient was reevaluated at follow up and found to have complete resolution of her episodes. Conclusion: In conclusion stress induced urticaria resulting from psychologic stress is a real phenomenon that can present abruptly and create intense stress and anxiety for patients. Patients should be evaluated for a preceding stressor, stressful event or traumatic experience. While diagnosis can be made by intradermal injection of epinephrine or norepinephrine to provoke a rash response, clinicians may rely on their clinical judgement, detailed history taking and robust physical examination for diagnosis. Ultimately resolution may be achieved through trigger avoidance, Other appropriate therapies may also including psychotherapy, medications such as oral propranolol, antidepressant and antihistamines for symptomatic relief.

as stated age. Patient had completed several ED visits with complaint of sporadic diffuse rashes that would appear after periods of extreme stress. Patient was extensively evaluated for infectious etiology with all test results being unremarkable. During the initial visit on physical exam she did not have any dermatological findings, mucosal involvement or systemic complaints. She subsequently revealed being extremely stressed about her finals and being away from home for the first time. Patient endorsed a psychiatric history and previously being followed by psychiatry. While discussing her past history of PTSD and being worried about living in a new town and trying to not fail classes, the patient abruptly developed pruritic wheals with and without surrounding erythematous flares located on her right forearm which started to ascend. After completing further physical examination the patient was diagnosed with stress induced urticaria. CBC, CMP and thyroid cascade were completed and found to be unremarkable. The patient was started on Zoloft and was

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