eMedicine Specialties > Dermatology > Allergy & Immunology
Urticaria, Papular: Differential Diagnoses & Workup
Updated: Jun 2, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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.
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References
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Further Reading
Keywords
urticaria, papular urticaria, insect bites, type I hypersensitivity reaction, id reaction, bug bites
Differential Diagnoses & Workup: Urticaria, Papular