Papular urticaria, also known as infantile moss or urticaria-like moss, is a common dermatological condition that occurs in children. The skin of children with this condition may have uniformly sized red papules or papule-like blistering rashes that are itchy and itchy and often linger and recur. The itching can make the child cry and irritable, and if the skin is scratched it can become septic due to secondary infection. The disease is common in infants and children, with a higher incidence in the spring and summer months. The prognosis of this disease is generally good. This disease is similar to water scabies in Chinese medicine. Some scholars also refer to this disease as blistering wet sores.
It is now almost universally believed that the onset of papular urticaria is related to insect bites, and can be said to be an exogenous metaplasia caused by arthropod bites. When a patient is bitten by an arthropod, such as bedbugs, fleas, mosquitoes, worms, etc., the insect saliva can be injected into the skin, and if the person has a tendency to allergic qualities, then the disease can be caused after several bites over several days. Most of the view is a delayed allergic reaction. The reasons for holding the above views are: first, the antigen made of the above-mentioned insects for skin testing, 90% of patients showed a positive reaction; second, the disease prevalence of the month with the insects love to bite people in the same season; third, the patient from the environment when the disease, to avoid contact with such insects, the results often make the patient’s condition suddenly cured; fourth, if the patient repeatedly bite for a long time can occur desensitization, so the disease since the child After the age of 7 years, the incidence of the disease gradually decreases with age, until middle-aged people basically do not have this disease.
In addition, some scholars suggest that a small number of patients may be allergic to certain foods, especially proteins.
Papulosquamous urticaria – diagnostic points
(1) The disease occurs in infants and children and is more common in summer and autumn. Sometimes several children in a family develop the disease at the same time.
(2) The typical lesion is a green bean or slightly large light red papule, hard in nature, often with a blister at the top, crusted after scratching, surrounded by a fusiform red halo, presenting a wind cluster after scratching, which reverts to its original shape even after the wind cluster subsides.
(3) It occurs on the trunk and proximal extremities. The damage is variable in number, appearing in batches, occurring diffusely or in a few clusters, often accompanied by gastrointestinal disorders, and a few patients sometimes present blisters.
(4) The duration of the disease varies, generally about 1 week or so more self-resolving, leaving temporary pigmentation, but new rashes can appear one after another, so the old and new lesions can be seen at the same time, until the weather turns cooler gradually healed, but the following year often occurs again.
(5) Intense itching, especially at night, often affects sleep, the child is disturbed. The epidermis peels off after scratching, which can easily lead to secondary infection.
Papular urticaria – clinical manifestations
Papular urticaria often develops in the spring, summer and autumn during the warm season, mainly in children and adolescents over 1 year old, especially before the school year. The disease tends to occur on the trunk and extremities, but the head and face are less commonly affected. The lesions appear as pemphigoid papules or pemphigoid blisters. Typically, the lesions are fusiform with a small central papule or blister. Tension blisters may also appear on the distal extremities and palmoplantar areas. The rash may be clustered or scattered, but is generally asymmetric. Children have severe itching, especially at night. The rash is often followed by purulent skin diseases such as impetigo due to scratching, but there are usually no systemic symptoms and the local superficial lymph nodes are not enlarged. The duration of the disease is about 1-2 weeks, and after the damage subsides, temporary hyperpigmentation may remain, but it is easy to recur. However, the disease may gradually resolve with increasing age or recurrence until it is no longer present.
The main manifestation of the disease is the appearance of a skin rash, which is fusiform, edematous red papules, starting as small granular papules, and then developing into soybean to peanut rice size, sometimes with blisters in the center of the papules, occasionally visible blood blisters, surrounded by a clear red halo, the rash often appears in batches, usually on the waist and back, limbs, clustered or sparsely distributed, the rash itchy, easy to scratch and cause secondary infection. The rash disappears in about 7-10 days, leaving light brown pigmentation, and the rash of new damage often occurs continuously, so the rash can be seen in the same person’s skin at different times.
According to Chinese medicine, the rash appears in batches, the papules are red and hard like grains, itching is obvious, crying and restless, the tongue is red or red at the edges, or there is also bad wind and fever, nasal congestion and runny nose, red throat and sore throat, and cough, which is the evidence of wind-heat congestion. If the rash is large, with blisters, itching and pain, yellow face and irritability, or mental fatigue, irregular bowel movements, yellow and red urine, loss of appetite, and a red tongue with yellow coating, this is a case of damp-heat stagnation. If the disease has been in progress for a long time, the rash is recurrent, red and itchy, with thirst and bad breath, abdominal pain, dry stools, grinding of teeth at night, loss of appetite, and a red tongue with a thick yellow coating, it is a case of stagnant heat.
The diagnosis can be made mainly based on the clinical features.
Papular urticaria needs to be differentiated from chickenpox, which is more common on the trunk, proximal extremities and head and face, and the oral mucosa is often involved. It is not itchy or mildly itchy, but patients often have systemic symptoms such as low-grade fever.
Papular urticaria is distinguished from urticaria in that the former is not a purely windy rash, but a mixed lesion, i.e., a windy papule or a windy blister.
Papular urticaria – disease treatment
I. Traditional methods:
The cause of papular urticaria is complex, such as the use of traditional control methods of treatment, such as hormones, antihistamines, anti-inflammatory drug therapy, a moment to see light, but after a period of time the disease will aggravate, so repeatedly form a vicious circle.
Urticaria, easy to recur, most of the traditional treatment of external drugs, injections, etc., to treat the symptoms but not the root cause, long-term use with a certain degree of resistance to drugs, bringing patients a lot of pain. Conrad’s experts are deeply aware of the limitations of traditional therapy and propose to cure urticaria in two ways at the same time:
(1) To carry out anti-allergy desensitization treatment, to completely change the allergic body.
(2) To completely remove the toxins in the human blood, reduce the blood heat and blood dryness, restore the normal blood circulation of the body.
II. Internal therapy
(1) antihistamines: can be used as a routine application, generally used both antihistamines, but also sedative effect of benadryl, fenugreek, paracetamol, saigentin and so on internal use. If the above drugs do not work, you can take “compound acid glycosides tablets”, the effect on the long-standing untreated papular urticaria is remarkable, its pharmacological effects: anti-inflammatory effect: anti-allergic effect. The pharmacological effects: anti-inflammatory effect: anti-allergic effect, obstruction of arachidonic acid metabolizing enzymes. Immunomodulatory effects. Inhibitory effect on experimental hepatocyte damage. Inhibition of viral proliferation and inactivation of viruses.
(B) Calcium: Calcium lactate or calcium gluconate tablets taken orally have some efficacy. Often used in combination with antihistamines.
(C) vitamins: often use vitamin C or B12 in combination with antihistamines, which can be expected to achieve better results.
(D) Chinese medicine treatment; this disease treatment to dispel wind and clear heat, but the editor’s experience, the disease application of four things soup (angelica, raw earth, white peony, Chuanxiong) or five ling san (zedoary, poria, pig ling, cinnamon, atractylodes) decoction, a daily payment, the effect is quite remarkable, worth a try.
Third, the external treatment
Symptomatic treatment, according to the performance of the lesions can be selected with anti-itch, anti-inflammatory effect of the lotion or emulsion external application, but if there is secondary infection, should first control the infection is appropriate.
Papulosquamous urticaria – disease prevention
A. Improve environmental, indoor and personal hygiene to eliminate the breeding of insects that cause this disease.
Insecticides can be sprayed indoors and outdoors to eliminate bedbugs, fleas, mosquitoes and other harmful arthropods.
This disease is a common disease in children in spring and autumn, especially after outdoor activities. Paying attention to personal hygiene and environmental sanitation, eliminating mosquitoes, fleas, J, bedbugs, etc., as well as avoiding allergenic food can reduce the occurrence of this disease. Try not to scratch to prevent secondary infection. The rash can subside naturally. Appropriate medication can improve the symptoms and speed up the rash. The descriptions of “earth wind sores”, “water scabies” and “fine skin rash” in Chinese medical literature are similar to this disease, which is mostly “caused by the deficiency of the muscle couples and the wind and dust entering the It is also caused by “internal dampness and heat, combined with wind and insect poisoning” and “internal food stagnation, external wind and evil”. The symptoms are mostly due to wind, dampness and heat. Many Chinese medicines have the effect of repelling insects and warding off obscenity, and have few side effects, so Chinese medicines are promising in the prevention and treatment of papular urticaria.
If the disease has developed, you can take paracetamol, benadryl, etc. You can also take the Chinese medicine rhinoceros horn poisoning pill, Saijin poisoning san, pediatric fragrant orange pill, etc. You can apply topical white lotion or bug bite water and other anti-itch agents. If there is secondary infection or long-term failure to heal, you should promptly go to the hospital for treatment.
Fourth, the diet avoid spicy stimulation, alcohol, seafood hair, beef, mutton and dog meat, etc.. If you are allergic to cosmetics, you should use them with caution to avoid skin irritation. Sensitive skin is prone to dryness and peeling, so pay attention to hydrating the skin and keeping it moisturized.
Papulosquamous urticaria – allergy-friendly foods
1. Milk and eggs. Milk and eggs play an important role in food allergies, and the number of patients allergic to these two foods is not only large, but most of them are in serious condition, and deaths due to allergies are common. Whey protein in milk and egg protein in eggs are the main allergic components, other eggs can also cause allergy, but less common.
2, fish, shrimp, crab and other seafood. This is also a group of foods that can easily cause allergies, often causing hives, etc.
3, meat. Such as pigs, cattle, sheep and poultry. Compared with eggs and milk above, this group of food allergies is not common in China, which may be related to the Chinese people’s habit of eating meat or poultry after a long time of steaming. Generally speaking, foreigners eat meat with a shorter heating time, which may be the reason for the higher number of allergic people abroad than in China.
4. Oil crops. Such as peanuts, soybeans, sesame, sunflower seeds, etc. These foods not only contain oil but also protein, which is also an important allergen.
5, drupe food. Such as walnuts, hazelnuts, almonds, pistachios, cashews, etc. Although not many people are allergic to this type of food, but the symptoms of allergic people can be very serious, some people can eat a grain of cashews can die of laryngeal edema asphyxiation.
6, fruit. Peaches, apples, pears, oranges (especially money oranges), bananas, lychees, strawberries and a variety of melons, such as watermelon, cucumber, cantaloupe and other major.
7, vegetables. Among vegetables, there are generally few allergic to cabbage and green vegetables, but lentils, cucumbers, bean sprouts, tomatoes, celery, carrots, etc. can cause allergies. Almost all of those who are allergic to soybean are allergic to soybean sprouts.
8, grains. Generally, oats, buckwheat and wheat are the main allergens, and allergy to millet also occurs, and less to rice. Wheat flour has a large amount of wheat gum, which can be hydrolyzed in the body to wheat gum protein, to which some people are allergic, but not IgE-mediated reactions (rapid-onset allergic reactions).
9. Food additives. More people are allergic to food coloring, preservatives, preservatives and flavoring agents, of which lemon yellow (No. 5 yellow) is the most common cause of asthma.
10, certain fermented foods. Such as beer, some patients are allergic to hops, some patients are allergic to edible yeast, and some are allergic to edible fungi.