eMedicine Specialties > Dermatology > Allergy & Immunology

Urticaria, Papular: Treatment & Medication

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

Treatment

Medical Care

The treatment of papular urticaria should be conservative.

  • Treatment of papular urticaria is symptomatic in most cases.
  • The use of insect repellents while outside and the use of flea and tick control on indoor pets are necessary when treating papular urticaria. For safety purposes, topical insecticides used on infants and children should be in accordance with their age.

Consultations

The following guidelines may be helpful: Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help.17

Medication

Treatment of papular urticaria includes mild topical steroids and systemic antihistamines for relief of the itching that often accompanies this condition. Papular urticaria may be severe enough to warrant the use of short-term systemic corticosteroids. If secondary impetigo occurs, topical or systemic antibiotics may be needed. Papular urticaria usually occurs in children.

Corticosteroids

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.


Triamcinolone 0.1% cream (Aristocort)

Indicated for the treatment of dermatitis. Midpotency topical corticosteroid that inhibits cell proliferation. Has immunosuppressive and anti-inflammatory properties.

Adult

Apply sparingly bid/qid as severity warrants

Pediatric

Administer as in adults

Documented hypersensitivity; herpes simplex infection; fungal, viral, or tubercular skin lesions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May cause adverse systemic effects if used over large areas, on denuded areas, on occlusive dressings, or during prolonged treatment periods


Prednisolone

Decreases inflammatory reactions by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Adult

40-60 mg/d PO divided 1-2 doses/d

Pediatric

0.5-2 mg/kg/d PO divided 2-4 doses/d

Decreases effects of salicylates and toxoids (for immunizations); phenytoin, carbamazepine, barbiturates, and rifampin decrease effects

Documented hypersensitivity; viral, fungal, or tubercular skin lesions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes, and myasthenia gravis

Antihistamines

These agents are type 1 histamine receptor blockers that act to block the action of histamine after its release from mast cells and basophils. They are most effective when used prophylactically. Two classes of antihistamines exist: sedating and nonsedating. Typically, the sedating antihistamines are stronger and have more anticholinergic adverse effects.


Cetirizine (Zyrtec)

Indicated for the treatment of allergies. Forms a complex with histamine for H1-receptor sites in blood vessels, GI tract, and respiratory tract.

Adult

5-10 mg PO qd

Pediatric

<2 years: Not established
2-5 years: 2.5 mg PO qd
>5 years: Administer as in adults

Increases CNS toxicity of depressants

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in hepatic or renal dysfunction; doses >10 mg/d may cause drowsiness

Antibiotics

Therapy must cover all likely pathogens in the context of this clinical setting.


Erythromycin (E-Mycin, E.E.S., Ery-Tab, Eryc, Erythrocin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes causing RNA-dependent protein synthesis to arrest.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

Adult

250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) PO q6h 1 h ac or 500 mg q12h
Alternatively, 333 mg PO q8h; increase to 4 g/d depending on severity of infection

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis; decreases metabolism of repaglinide, thus increasing serum levels and effects

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue if nausea, vomiting, malaise, abdominal colic, or fever occur

More on Urticaria, Papular

Overview: Urticaria, Papular
Differential Diagnoses & Workup: Urticaria, Papular
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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