Papular Urticaria
An acute, sub-acute or chronic inflammation of the skin, caused by endogenous or exogenous agents. Urticaria is an
itchy skin rash.
Causes
- Endogenous: familial, also associated with other allergic diseases
- Exogenous: agents include sunlight, chemicals, certain foods, insect bites
Clinical features
- Inflammation of skin: transient itching hives and wheals
- Papular urticaria: vesicles, redness, oedema, oozing in site of insect bites
Differential diagnosis
- Fungal and bacterial infections of the skin
- Helminth infestations
Investigations
- No satisfactory investigations for skin allergy
- Blood: haemogram to demonstrate eosinophilia
- Stool: microscopy to exclude worms
MANAGEMENT
- Establish the cause and treat accordingly. Identify what the patient is allergic to.
- Give an analgesic e.g. paracetamol for any pain or discomfort as necessary
- Avoid acetylsalicylic acid
- Give an antihistamine to relieve itching; chlorphenamine 4 mg every 8 hours
Child: 1-2 mg per dose - Or promethazine 25 mg at night. Increase to every 12 hours if necessary
Child: 1 mg/kg daily in 1-2 divided doses
If severe/unresponsive
- Prednisolone 1 mg/kg orally once a day for 3-5 days
Prevention
- Avoid contact with known allergens
- Treat helminth infections