Urticaire fessier géant en consultation dermatologique chez une secrétaire de bureau

Urticaria is a fleeting papulous edematous pruritic rash on the skin, most often caused by an allergic reaction (food, drugs, insect bites, etc.). It can be acute, lasting less than 6 weeks or chronic, with recurrent episodes for more than 6 weeks. Chronic urticaria (UC) is a frequent reason for consultation. Patients management is often difficult due to its significant impact on the quality of life, its potential association with many underlying diseases and a sometimes insufficient response to first line treatment. The prevalence of urticaria in the general population is 0.6%-1.3%. Women are more frequently affected than men (3.8 times). Therapy is focused on reducing pruritus, size, number and frequency of lesions and is based on antihistamines and avoidance of exposure to contributing factors. We here report a case of chronic giant urticaria on the gluteal region in a 36-year-old office secretary with a history of chronic urticaria treated with Loratadine (10 mg tablet, once daily), presenting with edematous pruritic papules on the buttocks occurred more than 3 days before. Physical examination showed large erythematous edematous pruritic papules coalescing into large plaques on both buttocks. The largest plaques measured 25/20 cm, while the smallest 4 cm/3cm. Complete blood count was performed, which showed leukocytosis (mainly eosinophilic polynuclear leukocytosis). The diagnosis of urticaria was retained based on clinical lesions. The patient received 40mg Solumedrol for injection (2 ampoules for 5 days) and Bilastine (20 mg tablet per day). Outcome was favorable under treatment, with complete remission of lesions and disappearance of pruritus.