Papular urticaria

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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

  • Insect bites
  • Impetigo
  • Scabies
  • Dermatitis herpetiformis
  • Papular pruritic rash (in HIV infection)


  • 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



  1. Hogewoning AA, et al. Skindiseases among schoolchildren in Ghana,Gabon and Rwanda.August 2012: Accepted for publication in the International Journal of Dermatology.
  2. Komba EV, Mgonda YM. The spectrum of dermatological disorders among primary school children in Dar es Salaam. BMC Public Health 2010; 10: 765.
  3. Ogunbiyi AO, Owoaje E, Ndahi A. Prevalence of skin disorders in school children in Ibadan, Nigeria. Pediatr Dermatol 2005; 22: 6-10.
  4. 4.0 4.1 Howard R, Frieden IJ. Papular urticaria in children. Pediatr Dermatol 1996; 13: 246-9.
  5. Steen CJ, Carbonaro PA, Schwartz RA. Arthropods in dermatology. J Am Acad Dermatol 2004; 50: 819-42.
  6. Demain JG. Papular urticaria and things that bite in the night. Curr Allergy Asthma Rep 2003; 3: 291-303.
  7. Raza N, Lodhi MS, Ahmed S et al. Clinical study of papular urticaria. J Coll Physicians Surg Pak 2008; 18: 147-50.
  8. Jordaan HF, Schneider JW. Papular urticaria: a histopathologic study of 30 patients. Am J Dermatopathol 1997; 19: 119-26.
  9. Stibich AS, Schwartz RA. Papular urticaria. Cutis 2001; 68: 89-91.
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