From the Guidelines
The treatment for papular urticaria primarily focuses on relieving symptoms and preventing further insect bites, with first-line treatment including topical corticosteroids and oral antihistamines, as supported by guidelines for evaluation and management of urticaria in adults and children 1.
Treatment Options
- Topical corticosteroids, such as hydrocortisone 1% cream, can be applied to affected areas 2-3 times daily for 7-10 days to reduce inflammation and itching.
- Oral antihistamines, like cetirizine (5-10mg daily) or diphenhydramine (25-50mg every 6 hours), can help control itching, with diphenhydramine being particularly useful at night due to its sedating effects 1.
Prevention and Additional Measures
- Prevention is crucial and includes using insect repellents containing DEET (10-30%), wearing protective clothing, eliminating standing water near homes, and washing bedding in hot water regularly.
- Scratching should be avoided to prevent secondary bacterial infections, and if infection occurs, topical antibiotics like mupirocin or oral antibiotics such as cephalexin (500mg four times daily for adults) may be needed.
Severe Cases
- For severe cases, a short course of oral prednisone (0.5-1mg/kg/day for 5-7 days) may be necessary, as oral corticosteroids may shorten the duration of acute urticaria 1. Papular urticaria is an allergic reaction to insect bites, typically from mosquitoes, fleas, or bedbugs, and symptoms usually resolve within 2-10 days with proper treatment and prevention of new bites.
From the Research
Treatment for Papular Urticaria
The treatment for papular urticaria is primarily symptomatic and focused on relieving the symptoms.
- The first-line therapy for chronic urticaria, which includes papular urticaria, is based on anti-H1 second-generation antihistamines 2, 3.
- In some cases, antihistamines may need to be up-dosed to control the symptoms 2.
- For patients who do not respond to antihistamines, other treatment options such as immunomodulatory treatments, H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines may be considered 3, 4.
- Omalizumab, a humanized monoclonal anti-immunoglobulin E, has been approved for the treatment of chronic urticaria that is unresponsive to H1 antagonists 3.
- Short-term systemic corticosteroids may also be used in some cases, especially when there is a risk of angioedema involving the respiratory tract 4.
Alternative Treatment Options
- Cyclosporine and leukotriene receptor antagonists may be considered as alternative treatment options for papular urticaria 3, 4.
- The choice of treatment depends on the severity of the symptoms, the presence of any underlying conditions, and the patient's response to initial therapy.
- It is essential to note that the treatment of papular urticaria should be individualized and guided by a healthcare professional 2, 3, 4.