Papular urticaria: A histopathologic study of 30 patients

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dc.contributor.authorJordaan H.F.
dc.contributor.authorSchneider J.W.
dc.date.accessioned2011-05-15T16:15:18Z
dc.date.available2011-05-15T16:15:18Z
dc.date.issued1997
dc.description.abstractPapular urticaria is the result of hypersensitivity (id-reaction) to bites from certain insects such as mosquitoes gnats, fleas, mites, and bedbugs. Papular urticaria is common in childhood and is characterized by symmetrically distributed pruritic papules and papulovesicles. Scratching causes erosions and ulcerations. Pyoderma is common. Lesions occur in crops. The histopathologic features of papular urticaria are inadequately documented. In a prospective study we recorded the histopathologic features of 30 patients (female, 18: male, 12) with papular urticaria. Their ages ranged from 6-343 months (median = 21 months, mean = 37.73 months). Features that presented in more than 50% of cases included mild acanthosis, mild spongiosis, exocytosis of lymphocytes, mild subepidermal edema, extravasation of erythrocytes, a superficial and deep mixed inflammatory cell infiltrate of moderate density, and interstitial eosinophils. We recognized lymphocytic (n = 4), eosinophilic (n = 9), neutrophilic (n = 7), and mixed (n = 9) subtypes. Immunohistochemistry was performed on formalin-fixed, paraffin embedded sections from 10 cases and revealed abundant T-lymphocytes (CD45RO, CD3) and macrophages (CD68) in all cases. B-lymphocytes (CD20) and dendritic antigen- presenting cells (S100) were absent. Direct immunofluorescence staining was conducted on cryostat-prepared sections from 26 specimens. Deposition of IgA, IgG, IgM, C3, and fibrin could not be demonstrated. The histopathologic differential diagnosis of papular urticaria includes other spongiotic dermatitides, pityriasis lichenoides et varioliformis acuta, the pruritic papular eruption of human immunodeficiency virus 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. The present study provides morphologic and immunohistochemical evidence that a type I hypersensitivity reaction plays a central role in the pathogenesis of papular urticaria. The putative antigen remains undetermined.
dc.description.versionArticle
dc.identifier.citationAmerican Journal of Dermatopathology
dc.identifier.citation19
dc.identifier.citation2
dc.identifier.issn01931091
dc.identifier.other10.1097/00000372-199704000-00004
dc.identifier.urihttp://hdl.handle.net/10019.1/13281
dc.subjectadolescent
dc.subjectadult
dc.subjectarticle
dc.subjectchild
dc.subjectclinical article
dc.subjectclinical feature
dc.subjectdifferential diagnosis
dc.subjectfemale
dc.subjecthistopathology
dc.subjecthuman
dc.subjectimmunohistochemistry
dc.subjectinfant
dc.subjectinflammatory infiltrate
dc.subjectinsect bite
dc.subjectlymphocytic infiltration
dc.subjectmale
dc.subjectpapule
dc.subjectpityriasis lichenoides
dc.subjectpriority journal
dc.subjectpyoderma
dc.subjectskin biopsy
dc.subjectskin tuberculosis
dc.subjecturticaria
dc.subjectAdolescent
dc.subjectAdult
dc.subjectB-Lymphocytes
dc.subjectCell Count
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectDendritic Cells
dc.subjectDiagnosis, Differential
dc.subjectEdema
dc.subjectEosinophils
dc.subjectEpidermis
dc.subjectErythrocytes
dc.subjectExocytosis
dc.subjectFemale
dc.subjectFluorescent Antibody Technique, Direct
dc.subjectHumans
dc.subjectHypersensitivity, Immediate
dc.subjectInfant
dc.subjectInsect Bites and Stings
dc.subjectLymphocytes
dc.subjectMacrophages
dc.subjectMale
dc.subjectNeutrophils
dc.subjectProspective Studies
dc.subjectPyoderma
dc.subjectReproducibility of Results
dc.subjectSkin Diseases, Papulosquamous
dc.subjectSkin Ulcer
dc.subjectT-Lymphocytes
dc.subjectUrticaria
dc.titlePapular urticaria: A histopathologic study of 30 patients
dc.typeArticle
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