Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(4):e2022225 1

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

A 51-year-old patient with metastatic colorectal cancer, 

treated with dabrafenib, trametinib and cetuximab, pre-

sented with the acute onset of yellowish skin lesions. On 

clinical examination, multiple itching, intense yellowish 

skin swellings on the trunk and extremities were observed. 

The unaffected skin, however, was not icteric, contrary to 

the sclerae (Figure 1 A-C). Besides marked leukocytosis and 

elevated liver function parameters (GGT 708 U/L, GOT 

80 U/L, GPT 52 U/L) laboratory investigations revealed 

a markedly increased serum bilirubin level (9.55  mg/dl; 

0.1-1.2). Our patient suffered from acute urticaria with 

wheals appearing yellowish due to marked elevated serum 

bilirubin. An association with the aforementioned drugs in 

our case is likely, but urticaria may also be induced by an 

inflammatory process in a patient suffering from cancer. 

The lesions resolved within a few days under antihista-

mine treatment, and the skin color of the previous promi-

nent yellowish lesions adapted to that of the surrounding 

skin. Due to his underlying disease, the patient died a few 

weeks later.

Teaching point

Novel therapies like checkpoint-inhibitors or immuno- 

oncological agents revolutionized treatment in several ad-

vanced malignancies. Consequently, a broad spectrum of 

adverse events in different degrees of severity can occur at 

any time of therapy, even after cessation of treatment.

Urticaria is a very common skin disease; yellow urticaria, 

however, is a seldom and unusual variant and to date no 

more than ten cases are reported since the first report in 

1969 and all hitherto reported cases have a hyperbilirubin-

emia as definitive cause in common [1,2].

References

1. Pollack MH, Betof A, Dearden H, et al. Safety of resuming 

anti-PD-1 in patients with immuni-related adverse events (irAEs) 

during combined anti-CTLA-4 and anti-PD1 in metastatic mela-

noma. Ann Oncol. 2018;29(1):250-255. DOI: 10.1093/annonc/

mdx642. PMID: 29045547. PMCID: PMC5834131.

2. Combalia A, Fustá X, Guilabert A, Mascaró JM Jr, Estrach T. 

Hyperbilirubinaemia: the common denominator of yellow urti-

caria. J Eur Acad Dermatol Venereol. 2017;31(12):e533. DOI: 

10.1111/jdv.14397. PMID: 28609589.



2 Image Letter | Dermatol Pract Concept. 2022;12(4):e2022225

Figure 1. (A) Clinical image showing the left arm with multiple yellowish skin swellings. (B) Close up. (C)Yellow-colored sclerae.