Fig. 1 Punctate wheals and erythema scattered on the chest after warming stimulation. Fig. 2 Time-Course of Histamine Value in Plasma during Exercise
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2 Fig. 1 Punctate wheals and erythema scattered on the chest after warming stimulation. Fig. 2 Time-Course of Histamine Value in Plasma during Exercise Challenge Fig. 3 Control subjects (Con 1, Con 2) showed positive sweat-delivery test, but the patient (Pt) showed negative after 10 minute-exercise challenge. Fig. 4 Sweat-delivery test on mecholyl injected-skin was positive in control subjects (Con), but negative in the patient (Pt).
3 Fig. 6 The eruption developed after the exercise challenge only on the left side of the trunk which did not received PUVA therapy, but not on the PUVA-received right side. Fig. 5 Histological findings on mecholyl injectedskin revealed hyperkeratosis in sweat pore and mild inflammation surrounding sweat duct. However, narrowing of sweat duct or spongiosis were not observed.
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5 36 : 790, Herxheimer A : The nervous pathway mediating cholinergic urticaria, Clin Sci, 15 : , Kaplan AP, Gray L,Shaff RE, Horakova Z, Beaven MA : In vivo studies of mediator release in cold urticaria and cholinergic urticaria, J Allergy Clin Immunol, 55 : , Soter NA, Wasserman SI, Austen F, MacFadden ER Jr : Release of mast-cell mediators and alterations in lung function in patients with cholinergic urticaria, N Eng. J Med, 302 : , Barlow RJ, Warburton F, Watson K, Black AK, Greaves MW : Diagnosis and incidence of delayed pressure urticaria in patients with chronic urticaria, J Am Acad Dermatol, 29 : , Danno K, Toda. K, Horio T : The effect of 8- methoxypsoralen plus long-wave ultraviolet (PUVA) radiation on mast cells : PUVA suppresses degranulation of mouse skin mast cells in- duced by compound 48 / 80 or concanavalin A, J Invest Dermatol, 85 : , Champion RH,Carpenter RG, Roger JH : Urticari 14. Toda K, Danno K, Tachibana T, Horio T : Effect of a and angio-oedema : A review of 554 patients,br 8-methoxypsoralen plus long-wave ultraviolet J Dermatol, 98 : , 1969 (PUVA) radiation on mast cells. II. In vitro PUVA 2. Moore-Robinson M, Warin RP : Some clinical aspects inhibits degranulation of rat peritoneal mast cells of cholinergic urticaria, Br J Dermatol, 80 : induced by compound 48/ 80, J Invest Dermatol, , : , Kolde G, Frosch. PJ, Czarnetzki BM : Response of cutaneous mast cells to PUVA in patients with urticaria pigmentosa : Histomorphometric, ultrastructual, and biochemical investigations, J Invest Dermatol, 83 : , Holzle E, Hofmann C, Plewig G PUVA-treatment 6. Illig L, Heinicke A : Zur pathogenese der for solar urticaria and persistent light reaction, cholinergische urticaria, Arch Klin Exp Dermatol, Arch Dermatol Res, 269 : 87-91, : , Parrish JA, Jaenicke KF, Morison WL, Momtaz K, Shea C : Solar urticaria : Treatment with PUVA and mediator inhibitors, Br J Dermatol, 106:575-
6 580, Midelfart K,Moseng D, Kavli G,Stenvold SE, Volden G : A case of chronic urticaria and vitiligo, associated with thyroiditis, treated with PUVA,Dermatologica, 167 : 39-41, Udassin R, Harari Z, Schoenfeld Y, Keren G : Cho linergic urticaria : A seasonal disease, Arch Intern Med, 141 : , Hirschmann JV, Lawlor F, English JSC, Louback JB, Winkelmann RK, Greaves MW : Cholinergic urticaria : A clinical and histological study,arch Dermatol, 123 : , 1987 Cholinergic Urticaria Associated with Hypohidrosis Masako Ohnuki, Hiroko Hashimoto and Takeshi Horio Department of Dermatology,Kansai Medical University 10-15, Fumizono-cho, Moriguchi, Osaka 570, Japan Key words : cholinergic urticaria, hypohidrosis A 42-year-old man developed tiny wheals surrounded by diffuse erythema associated with tingling or irritating feeling after exercise or emotional stress. He had a positive mecholyl skin test with numerous satellite lesions and generalized punctate urticaria following exercise challenge. Hypohidrosis was also found in these challenge tests. Thus the diagnosis of hypohidrotic cholinergic urticaria was made. Histological examination from mecholyl injected-skin revealed hyperkeratosis in sweat pore, but not narrowing of sweat duct nor retention of sweat. The administration of various drugs were not effective. The symptom improved associated with increased sweating by daily exercise and heating challenge. The pathomechanisms of this disorder were not clear. In our patient, histamine release in the plasma was not observed during exercise challenge. PUVA therapy improved wheal formation but not pain, suggesting that the different mediators are involved in each of them. Skin Research, 38 : , 1996
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