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Urticaria, Papular: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Jun 2, 2009

Differential Diagnoses

Dermatitis Herpetiformis
Id Reaction (Autoeczematization)
Impetigo
Insect Bites
Pityriasis Lichenoides

Other Problems to Be Considered

The histopathologic differential diagnosis of papular urticaria includes other spongiotic dermatitides, pityriasis lichenoides et varioliformis acuta, the pruritic papular eruption of human immunodeficiency virus (HIV) disease, and papulonecrotic tuberculid. Papular urticaria with marked spongiosis and a dense inflammatory cell infiltrate cannot be reliably distinguished from arthropod bites on clinical and histopathologic grounds.

Workup

Histologic Findings

In a prospective study of papular urticaria, the histopathologic features were evaluated in 30 patients with papular urticaria.7 More than 50% of patients had mild acanthosis, mild spongiosis, exocytosis of lymphocytes, mild subepidermal edema, extravasation of erythrocytes, superficial and deep mixed inflammatory cell infiltrate of moderate density, and interstitial eosinophils. Immunohistochemical analysis revealed abundant T lymphocytes (CD45RO, CD3) and macrophages (CD68). B lymphocytes (CD20) and dendritic antigen-presenting cells (S100) were not seen. Direct immunofluorescence staining did not demonstrate immunoglobulin A (IgA), immunoglobulin G (IgG), IgM, C3, or fibrin.

More on Urticaria, Papular

Overview: Urticaria, Papular
Differential Diagnoses & Workup: Urticaria, Papular
Treatment & Medication: Urticaria, Papular
Follow-up: Urticaria, Papular
Multimedia: Urticaria, Papular
References

References

  1. Stibich AS, Schwartz RA. Papular urticaria. Cutis. Aug 2001;68(2):89-91. [Medline].

  2. Lewis-Jones MS. Papular urticaria caused by Dermestes maculatus Degeer. Clin Exp Dermatol. Mar 1985;10(2):181. [Medline].

  3. Garcia E, Halpert E, Rodriguez A, Andrade R, Fiorentino S, Garcia C. Immune and histopathologic examination of flea bite-induced papular urticaria. Ann Allergy Asthma Immunol. Apr 2004;92(4):446-52. [Medline].

  4. Cuellar A, Rodriguez A, Rojas F, Halpert E, Gomez A, Garcia E. Differential Th1/Th2 balance in peripheral blood lymphocytes from patients suffering from flea bite-induced papular urticaria. Allergol Immunopathol (Madr). Jan-Feb 2009;37(1):7-10. [Medline].

  5. Burns DA. Papular urticaria produced by the mite Listrophorus gibbus. Clin Exp Dermatol. May 1987;12(3):200-1. [Medline].

  6. Yoshikawa M. Skin lesions of papular urticaria induced experimentally by Cheyletus malaccensis and Chelacaropsis sp. (Acari: Cheyletidae). J Med Entomol. Jan 18 1985;22(1):115-7. [Medline].

  7. Jordaan HF, Schneider JW. Papular urticaria: a histopathologic study of 30 patients. Am J Dermatopathol. Apr 1997;19(2):119-26. [Medline].

  8. Demain JG. Papular urticaria and things that bite in the night. Curr Allergy Asthma Rep. Jul 2003;3(4):291-303. [Medline].

  9. Bronstein DE, Cotliar J, Votava-Smith JK, Powell MZ, Miller MJ, Cherry JD. Recurrent papular urticaria after varicella immunization in a fifteen-month-old girl. Pediatr Infect Dis J. Mar 2005;24(3):269-70. [Medline].

  10. Heng MC, Kloss SG, Haberfelde GC. Pathogenesis of papular urticaria. J Am Acad Dermatol. Jun 1984;10(6):1030-4. [Medline].

  11. Altraide DD, George IO, Frank-Briggs AI. Prevalence of skin diseases in Nigerian children--(the University of Port Harcourt Teaching Hospital) experience. Niger J Med. Oct-Dec 2008;17(4):417-9. [Medline].

  12. Steen CJ, Carbonaro PA, Schwartz RA. Arthropods in dermatology. J Am Acad Dermatol. Jun 2004;50(6):819-42, quiz 842-4. [Medline].

  13. Howard R, Frieden IJ. Papular urticaria in children. Pediatr Dermatol. May-Jun 1996;13(3):246-9. [Medline].

  14. Raza N, Lodhi MS, Ahmed S, Dar NR, Ali L. Clinical study of papular urticaria. J Coll Physicians Surg Pak. Mar 2008;18(3):147-50. [Medline].

  15. Naimer SA, Cohen AD, Mumcuoglu KY, Vardy DA. Household papular urticaria. Isr Med Assoc J. Nov 2002;4(11 Suppl):911-3. [Medline].

  16. Lembo S, Panariello L, d'Errico FP, Lembo G. Professional's and non-professional's papular urticaria caused by Scleroderma domesticum. Contact Dermatitis. Jan 2008;58(1):58-9. [Medline].

  17. [Guideline] American Academy of Allergy, Asthma & Immunology. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. J Allergy Clin Immunol. Feb 2006;117(2 Suppl Consultation):S495-523. [Medline].

  18. Giraldi S, Ruiz-Maldonado R, Tamayo L, Sosa-de-Martinez C. Oral desensitization in papular urticaria in children. Trop Doct. Jul 2002;32(3):142-5. [Medline].

  19. Smith SR, Macfarlane AW, Lewis-Jones MS. Papular urticaria and transfer of allergy following bone marrow transplantation. Clin Exp Dermatol. Jul 1988;13(4):260-2. [Medline].

Further Reading

Keywords

urticaria, papular urticaria, insect bites, type I hypersensitivity reaction, id reaction, bug bites

Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Alexa F Boer Kimball, MD, MPH, Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital and Brigham and Women's Hospital
Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center
Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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