eMedicine Specialties > Dermatology > Allergy & Immunology

Urticaria, Papular: Follow-up

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

Follow-up

Further Inpatient Care

  • Persistent nodules may suggest the possibility of a lymphoma, not papular urticaria, and require a skin biopsy specimen.

Deterrence/Prevention

  • Rigorous use of an effective insecticide may prevent insect bites and accordingly papular urticaria. Insecticides containing diethyltoluamide (DEET) are among the most beneficial.
  • An oral desensitization vaccine has been attempted, but the vaccine was deemed ineffective and the study sample size was too small for statistical significance.18

Complications

  • Few complications occur. The main complication of papular urticaria is simple and annoying persistence of the pruritic nodules. Occasionally, a secondary bacterial infection may occur.

Prognosis

  • The prognosis for patients with papular urticaria is excellent; however, it can be distressing to patients and their families.

Patient Education

  • Patients should be educated that papular urticaria is a benign self-limited eruption.

Miscellaneous

Medicolegal Pitfalls

  • The occasional overlapping in histologic pattern between papular urticaria exhibiting the histologic features of pseudolymphoma and a true lymphoma can cause problems.

Special Concerns

  • Smith et al reported on the transfer of an allergy via bone marrow transplantation.19
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Adam S. Stibich, MD, and Christy Shaffer, to the development and writing of this article.



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Treatment & Medication: Urticaria, Papular
Follow-up: Urticaria, Papular
Multimedia: Urticaria, Papular
References
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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].

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Further Reading

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Keywords

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

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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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