Neutrophilic urticaria

We studied 241 consecutive skin biopsies from patients with urticaria. Ten of the 241 specimens showed inflammation of dermal venules primarily with polymorphonuclear leukocytes, without evidence of necrotizing vasculitis. We speculated that this finding might represent an early histological form of urticarial vasculitis. However, review of the clinical histories and laboratory data from these 10 cases showed that most were associated with dermographism, normocomplementaemia, and negative direct immunofluorescence. These findings suggest that urticarial lesions with the histological picture of neutrophils in vessel walls may imply the presence of physical urticaria.