URTICARIA PAPULOSA (CALLED PRURIGO SIMPLEX, LICHEN URTICATUS)

Papular urticaria, also called prurigo simplex, lichen urticatus, and strophulus pruriginosus, i.s a common disease of infancy and childhood. It appears during the wanner monllis, is more common in lower social and economic groups, and usually disappears upon admission to the hospital. Sehaffer, Spencer and Blank in 1948 proved by skin tests with flea and bedbug

Papular urticaria picture

Lichen urticatus. Similar lesions were upon the legs

antigen that papular urticaria is caused by hypersensitivity to flea and bedbug bites in at least 90 per cent of the cases. Their work confirms the suggestions made by Dietrich in Germany in 1938.

Pruritic skin lesions appear every spring or summer, usually in crops. They are distributed mostly on the arms and legs, especially on the extensor surfaces; also on the face and neck and usually least on the trunk. The in­dividual fresh lesions are small urtieated papules which become rubbed, excoriated and secondarily infected or liehenified, .sometimes with im­petiginous crusts or ccthymatous ulcers.

The lesions recur in crops, usually at night. All stages of development and regression of the papules may be noted at the same time. The attack lasts a week or two, but the disease may persist for months or years. Very frequently the attacks are seasonal. Usually tliere are no palpable lymphatic glands and no constitutional symptoms.

Treatment is by prophylaxis against all types of insects. The stool should be examined for intestinal parasites in baffling cases. The amount of candy, sweets, tomatoes and citrus fruits in the diet should be regulated. Anti­pruritic lotions are prescribed. In conjunction it is advisable to give treatment

Papular urticaria

 for fleas by DDT sprayed onto the carpets, floors, overstuffed chairs, in basements and into dog kennels or sleeping places of animals (sec p. 441).