Papular urticaria

The diagnosis of papular urticaria has evolved over the years and has many synonyms. Its most common present day usage relates to a cutaneous reaction presumably from an apparent exposure to insects. The evolving science in this area is allowing a better understanding of potential sources including newer tools to look at antigens from insect proteins injected after bites from flying insects and some other environmental arthropods. Insight to etiology is important and can be partially determined by clinical history and clinical pattern of symptoms. The usual approach in practice is to treat symptomatically first while investigating etiologies. Increasing appreciation of the role of environmental mites and ectoparasites has allowed us more precision in diagnosis to specifically treat the cause. The primary challenge in therapy often relates to the achievement of the goal of symptom relief. This is often difficult because of the chronicity of the syndrome when the patient is seen by a specialist. Both the search for etiology and symptomatic relief often need to be aggressive to achieve the desired therapeutic benefit for the patient.