What are the signs and symptoms of papular urticaria?

Updated: Feb 12, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Children, adult males, nonlocal inhabitants, and those belonging to urban or periurban areas may be more vulnerable to papular urticaria. [27] Patients usually report chronic or recurrent episodes of a papular eruption that tends to occur in groups or clusters associated with intense pruritus. The most common first appearance is of papules and urticarial plaques in clusters over exposed and covered parts of the body.

The eruption is characterized by crops of symmetrically distributed pruritic papules and papulovesicles. The lesions can also appear in an area localized to the site of insect bites, but they occur on any body part. The lesions tend to be grouped on exposed areas (see the image below), particularly the extensor surfaces of the extremities. Sometimes, a central hemorrhagic punctum may be evident with ecchymoses and brownish pigmentation persisting after resolution. [22] Scratching may produce erosions and ulcerations. Secondary impetigo or pyoderma is common. Having pets and the use of colognes were identified as predisposing factors for insect bite dermatitis in one large study, whereas atopy was not. [28] However, often children with papular urticaria are atopic and require evaluation for both conditions. [29]

Papular urticaria. Papular urticaria.

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