10.5826/dpc.1204a225
text/xml
2160-9381
2395
en
Birger Kränke
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Urticaria
Yellow urticaria
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2022-10-31
2022-02-14
2022-10-31
2022-12-05
e2022225
Dermatol Pract Concept
Birger Kränke
2022/10/31
10.5826/dpc.1204a225
e2022225
Department of Dermatology and Venereology, Medical University of Graz, Austria
2160-9381
Urticaria
en
e2022225
Combalia A, Fustá X, Guilabert A, Mascaró JM Jr, Estrach T. Hyperbilirubinaemia: the common denominator of yellow urticaria. J Eur Acad Dermatol Venereol. 2017 Dec;31(12):e533.
Yellow urticaria
https://dpcj.org/index.php/dpc/article/download/2395/1817
                                                 Yellow Urticaria
                                               Teresa Kränke1, Birger Kränke1


1 Department of Dermatology, Medical University of Graz, Graz, Austria



Citation: Kränke T, Kränke B. Yellow urticaria. Dermatol Pract Concept. 2022;12(4):e2022225. DOI: https://doi.org/10.5826/
dpc.1204a225
Accepted: March 29, 2022; Published: October 2022
Copyright: ©2022 Kränke et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Prof. Birger Kränke, MD, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz,
Austria. Phone: +43 31638512204 E-mail: birger.kraenke@medunigraz.at




Case presentation                                                        Teaching point
A 51-year-old patient with metastatic colorectal cancer,                 Novel therapies like checkpoint-inhibitors or immuno-­
treated with dabrafenib, trametinib and cetuximab, pre-                  oncological agents revolutionized treatment in several ad-
sented with the acute onset of yellowish skin lesions. On                vanced malignancies. Consequently, a broad spectrum of
clinical examination, multiple itching, intense yellowish                adverse events in different degrees of severity can occur at
skin swellings on the trunk and extremities were observed.               any time of therapy, even after cessation of treatment.
The unaffected skin, however, was not icteric, contrary to                    Urticaria is a very common skin disease; yellow urticaria,
the sclerae (Figure 1 A-C). Besides marked leukocytosis and              however, is a seldom and unusual variant and to date no
elevated liver function parameters (GGT 708 U/L, GOT                     more than ten cases are reported since the first report in
80 U/L, GPT 52 U/L) laboratory investigations revealed                   1969 and all hitherto reported cases have a hyperbilirubin-
a markedly increased serum bilirubin level (9.55 mg/dl;                  emia as definitive cause in common [1,2].
0.1-1.2). Our patient suffered from acute urticaria with
wheals appearing yellowish due to marked elevated serum
                                                                         References
bilirubin. An association with the aforementioned drugs in
our case is likely, but urticaria may also be induced by an               1. Pollack MH, Betof A, Dearden H, et al. Safety of resuming
inflammatory process in a patient suffering from cancer.                     anti-PD-1 in patients with immuni-related adverse events (irAEs)
                                                                             during combined anti-CTLA-4 and anti-PD1 in metastatic mela-
The lesions resolved within a few days under antihista-
                                                                             noma. Ann Oncol. 2018;29(1):250-255. DOI: 10.1093/annonc/
mine treatment, and the skin color of the previous promi-
                                                                             mdx642. PMID: 29045547. PMCID: PMC5834131.
nent yellowish lesions adapted to that of the surrounding                 2. Combalia A, Fustá X, Guilabert A, Mascaró JM Jr, Estrach T.
skin. Due to his underlying disease, the patient died a few                  Hyperbilirubinaemia: the common denominator of yellow urti-
weeks later.                                                                 caria. J Eur Acad Dermatol Venereol. 2017;31(12):e533. DOI:
                                                                             10.1111/jdv.14397. PMID: 28609589.




Image Letter | Dermatol Pract Concept. 2022;12(4):e2022225                                                                                 1
Figure 1. (A) Clinical image showing the left arm with multiple yellowish skin swellings. (B) Close up. (C)Yellow-colored sclerae.




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