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Table 1 Conditions to consider in the differential diagnosis of urticaria.

From: Urticaria and angioedema

Urticarial vasculitis • Lesions are usually painful (rather than pruritic), last >48 hours, and leave discoloration on the skin
Systemic mastocytosis • Rare condition that involves the internal organs (liver, spleen, lymph nodes, bone marrow), in addition to the skin
Atopic dermatitis • Chronic, highly pruritic inflammatory skin disease
• Clinical manifestations vary with age
Bullous pemphigoid • Chronic, autoimmune, blistering skin disease
Erythema multiforme • Acute, self-limited, skin condition
• Considered to be a type IV hypersensitivity reaction to certain infections, medications, and other various triggers
Familial cold autoinflammatory syndrome • Rare, inherited inflammatory disorder characterized by recurrent episodes of rash, fever/chills, joint pain, and other signs/symptoms of systemic inflammation triggered by exposure to cooling temperatures
• Onset usually occurs during infancy and early childhood and persists throughout the patient’s life
Fixed drug eruptions • Lesions occur from exposure to a particular medication and occur at the same site upon re-exposure to the offending medication
• Lesions usually blister and leave residual pigmentation
Subacute cutaneous lupus erythematosus • A non-scarring, photosensitive skin condition
• May occur in patients with systemic lupus erythematosus (SLE) and Sjögren syndrome
Pruritic urticarial papules and plaques of pregnancy • Benign skin condition that usually arises late in the third trimester of a first pregnancy
Muckle-Wells syndrome • Rare genetic disease that causes hearing loss and recurrent hives
• May lead to amyloidosis
Schnitzler's syndrome with monoclonal IgG kappa gammopathy • Rare disease characterized by chronic, non-pruritic hives, periodic fever, bone and joint pain, swollen lymph glands and an enlarged spleen and liver