From the Guidelines
Papular urticaria is best treated with a combination of avoiding the insect causing the bites, topical treatments, and oral medications for symptom relief, with the most recent guidelines suggesting the use of antihistamines as the first-line treatment, and omalizumab or cyclosporine for more severe cases 1. The treatment approach should prioritize the patient's quality of life, morbidity, and mortality, and the choice of treatment should be based on the severity of the symptoms and the patient's response to previous treatments. Some key considerations in the treatment of papular urticaria include:
- Identifying and eliminating the source of bites by cleaning living spaces, washing bedding in hot water, and using insect repellents
- Applying topical corticosteroids like hydrocortisone 1% cream to affected areas 2-3 times daily for up to 2 weeks to reduce inflammation and itching
- Using oral antihistamines such as cetirizine (10mg daily), loratadine (10mg daily), or diphenhydramine (25-50mg every 6 hours) to control itching
- Considering the use of omalizumab or cyclosporine for more severe cases, as recommended by the most recent guidelines 1
- Monitoring the patient's response to treatment and adjusting the treatment plan as needed to minimize morbidity, mortality, and improve quality of life. It is also important to note that the treatment of papular urticaria should be individualized, and the patient's specific needs and circumstances should be taken into account when developing a treatment plan, as suggested by the guidelines 1.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily
- Papular urticaria is a type of skin irritation caused by insect bites, which is listed as one of the uses for hydrocortisone (TOP) 2 and 2.
- The treatment for papular urticaria using hydrocortisone (TOP) involves applying the medication to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older.
- For children under 2 years of age, it is recommended to ask a doctor before applying hydrocortisone (TOP) 2.
From the Research
Treatment Options for Papular Urticaria
- The mainstay of treatment for urticaria, including papular urticaria, is avoidance of triggers, if identified 3.
- Second-generation H1 antihistamines are the first-line pharmacotherapy for urticaria, which can be titrated to greater than standard doses 3, 4, 5.
- First-generation H1 antihistamines, H2 antihistamines, leukotriene receptor antagonists, high-potency antihistamines, and brief corticosteroid bursts may be used as adjunctive treatment for urticaria 3, 4, 6.
- For refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine 3, 5, 6.
Specific Considerations for Papular Urticaria
- Papular urticaria is a common and often distressing childhood disorder manifested by chronic or recurrent papules caused by a hypersensitivity reaction to the bites of mosquitoes, fleas, bedbugs, and other insects 7.
- The histopathology of papular urticaria consists of mild subepidermal edema, extravasation of erythrocytes, interstitial eosinophils, and exocytosis of lymphocytes 7.
- Non-pharmacotherapeutic means to minimize hyper-responsive skin are also important and recommended, such as prevention skin from drying, avoidance of hot shower, scrubbing, and excessive sun exposure 5.