A case of chronic spontaneous urticaria with wheals lasting for more than a week

Urticaria is characterized by the development of wheals which usually disappear within a day, and are not present beyond a few days. A 58-year-old man began to develop edematous, partially ring-shaped erythematous lesions accompanied by severe body itching without any particular cause, approximately 2 months before his first visit to our hospital. Each rash emerged as being about 5 mm in diameter, gradually enlarging over several days, and disappeared in up to 10 days. Despite oral treatment with several antihistamines and 10 mg of prednisolone, there was no improvement. Most eruptions disappeared without a trace, but the erythema that appeared on the palms left desquamation. The patient had a history of shellfish allergy, but otherwise no atopic diseases. Drug eruption was ruled out due to a lack of regular taking other medications. Histopathological findings of the skin lesions showed moderate lymphocytic and few eosinophilic infiltrates with edema, but no evidence of vasculitis. Despite the concomitant use of two second-generation antihistamines and montelukast, the rash did not improve. The symptoms began to improve following oral intake of 1.5 mg of betamethasone, which was tapered off with the addition of 150 mg of cyclosporin. The use of all medications was stopped at 4 months from the first visit without recurrence. Wheals of chronic spontaneous urticaria may last for longer than a week without apparent histopathological findings of vasculitis.