PAPULAR URTICARIA: DIAGNOSIS AND MANAGEMENT IN PRIMARY HEALTHCARE

Papular urticaria is commonly seen in emergency departments and primary healthcare clinics and is often incorrectly diagnosed as atopic eczema. This annoying condition is caused by a chronic relapsing hypersensitivity reaction to mostly biting insects. The lesions are intensely pruritic. Owing to continuous scratching, lesions often become secondarily infected. Although adults are also affected, children are more likely to suffer from papular urticaria. Lesions are typically confined to the skin, but in rarer cases, systemic involvement and even anaphylaxis may ensue in susceptible individuals. Insects may also be vectors of various viruses, bacteria and parasites and can transmit vector-borne diseases, for instance, malaria. Although this is a mostly benign condition that is outgrown, some patients with papular urticaria may have serious underlying systemic illnesses or may be immunocompromised. In this article, common offenders, including fleas, bed bugs and mosquitoes, are discussed; as an underlying cause of papular urticaria, scabies is also highlighted. Diagnostic guidance for primary healthcare practitioners, practical examples of insect and parasite eradication and avoidance strategies, in addition to the supportive treatments available in primary healthcare clinics and emergency departments, are explored.