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What is Papular Urticaria?

By D. Jeffress
Updated Mar 03, 2024
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Papular urticaria is a very common skin condition among young children. It is characterized by multiple small, red, itchy bumps that are most often seen on the extremities. The exact causes of the condition are not known, but it is strongly suspected the bumps are the result of allergic reactions to certain types of insects. Most outbreaks of papular urticaria can be managed with topical creams and oral antihistamines, and the majority of patients outgrow the condition by the time they reach adolescence or early adulthood.

Fleas, mites, bedbugs, mosquitoes, and several other kinds of insects may be responsible for the urticaria. Bug bites precede many outbreaks, but it is possible for reactions to occur in absence of a bite. Allergies may be triggered by chemical traces left behind when insects crawl on the skin or simply exist in large numbers in a particular region. Most children experience reactions in the spring and summer months when bug populations are generally at their most active.

Exposed areas of skin on the legs and arms are common sites for papular urticaria. Outbreaks may also occur on the neck, chest, back, and occasionally on the face. Clusters of red papules tend to erupt simultaneously and can cover a fairly large area of skin, though individual bumps are rarely larger than 0.5 inches (about 1.25 cm) in diameter. Bumps may turn into pus-filled blisters one to two days after they appear and become extremely itchy.

Most cases of mild or infrequent papular urticaria do not require a trip to the doctor's office. Parents can treat their children at home with over-the-counter anti-inflammatory ointments, such as hydrocortisone creams. Calamine lotions and similar emollients can soothe itching sensations, and oral antihistamines help children become comfortable enough to rest at night. If skin symptoms fail to resolve or reappear on a frequent basis, a doctor can evaluate the situation and recommend other treatment options.

A physician may decide to prescribe a high-strength topical corticosteroid in serious cases of papular urticaria. Antibiotics might also be necessary if blisters have been ruptured and infected. The doctor can also help patients and their parents understand what triggers symptoms and what they can do to reduce the risks of outbreaks in the future. Using insect repellent sprays outdoors and wearing clothing that leaves less skin exposed are helpful in many cases. Parents may also be encouraged to thoroughly wash carpets, bedding, and furniture and to consider having their homes sprayed with non-toxic insecticides.

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Discussion Comments

By ysmina — On Jul 28, 2013

I've had papular urticaria since I was a child. I was supposed to outgrow it but it never happened. My doctor says that this is very rare, but clearly it happens.

By literally45 — On Jul 28, 2013

@ZipLine-- Do you use insect repellent when going outside?

My son's doctor said that using insect repellants outside should prevent papular uricaria hives to a large degree. I am doing this and it seems to be working so far. But at the same time, it's fall now and my son has this problem mostly in the spring and summer.

By ZipLine — On Jul 27, 2013

My daughter has papular urticaria. It's enough if an insect touches her, she will break out in a rash. The rash is usually localized to that area but it itches a lot and it's hard to prevent her from scratching it. My biggest worry is that she's going to cause an infection one day by scratching the rash.

I've tried several different ointments for it. We've even given her oral antihistamines. But considering how often she has this reaction, I don't want her to be taking medications so frequently. As for the ointments, what seems to be working best is aloe vera gel with lidocaine. I get this OTC from the pharmacy and it's great. It relieves the pain and itching in minutes. I carry it around with me everywhere.

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