Papular urticaria
Contents |
Epidemiology
Papular urticaria is regularly seen among schoolchildren in sub-Sahara Africa, especially in countries with a hot and humid climate.[1][2][3] The prevalence rate in Europe and the USA is unknown but it tends to be more evident during spring and summer months.[4] Papular urticaria are mainly seen among children between the age of 2 and 12.
Etiology and pathogenesis
Papular urticaria is a hypersensitive reaction to bites by arthropods, especially insects such as mosquitoes, fleas, mites, flies and bedbugs.[4][5][6][7] A type I hypersensitivity reaction plays a central role in the pathogenesis of papular urticaria but delayed type (type IV) reactions play a role as well. Children eventually outgrow this disease, probably through desensitization. There may be a relation with atopy and poverty.
Clinical findings
The classic presentation of papular urticaria includes crops recurrent pruritic papules and papulovesicles and varying degrees of local edema. Individual papules may surround a wheal and display a central point. Scratching causes erosions and ulcerations, so secondary pyoderma is common.[8][9]
Differential diagnosis
Management
- Prevention: use insect repellents and impregnated bed nets.
- Mild topical steroids like hydrocortisone 1% two times daily.
- Topical antipruritics such as calamine lotion. Gels or lotions containing menthol or camphor may also be used sparingly in children. Do not use in infants.
- Systemic sedating antihistamines like piriton or promethazine can be tried for relief of the itching. For dosages see urticaria.
- In case of a secondary infection oral antibiotics like cloxacillin or erythromycin can be given.For dosages see impetigo
Photos
Severe itching paules in a Ghanaian schoolboy...
Papular urticaria in a young child
Literature
- ↑ Hogewoning AA, et al. Skindiseases among schoolchildren in Ghana,Gabon and Rwanda.August 2012: Accepted for publication in the International Journal of Dermatology.
- ↑ Komba EV, Mgonda YM. The spectrum of dermatological disorders among primary school children in Dar es Salaam. BMC Public Health 2010; 10: 765.
- ↑ Ogunbiyi AO, Owoaje E, Ndahi A. Prevalence of skin disorders in school children in Ibadan, Nigeria. Pediatr Dermatol 2005; 22: 6-10.
- ↑ 4.0 4.1 Howard R, Frieden IJ. Papular urticaria in children. Pediatr Dermatol 1996; 13: 246-9.
- ↑ Steen CJ, Carbonaro PA, Schwartz RA. Arthropods in dermatology. J Am Acad Dermatol 2004; 50: 819-42.
- ↑ Demain JG. Papular urticaria and things that bite in the night. Curr Allergy Asthma Rep 2003; 3: 291-303.
- ↑ Raza N, Lodhi MS, Ahmed S et al. Clinical study of papular urticaria. J Coll Physicians Surg Pak 2008; 18: 147-50.
- ↑ Jordaan HF, Schneider JW. Papular urticaria: a histopathologic study of 30 patients. Am J Dermatopathol 1997; 19: 119-26.
- ↑ Stibich AS, Schwartz RA. Papular urticaria. Cutis 2001; 68: 89-91.
