This is a case of pigmented urticaria with a bumpy course of treatment to share with you: patient, male, 1 year and 1 month old. He was seen for 17 days for the appearance of red and purple spots on the marginal skin with itching. On October 9, 2015, the patient began to have erythema and itching with fever of 39 degrees, and was seen at an affiliated hospital, where hospitalization was recommended considering the severity of the disease. At this time, the patient’s rash was recurrent, and some of the skin remained purple-black patches after fading, with rough skin and a small amount of scales at the lesions. “On October 20, the patient went to the dermatology department of the affiliated hospital again, and was considered to have “acute urticaria” and was given dimethylphenidate, pulsatilla, skin itching granules and glyburide, but the effect was still poor. He came to our department in the afternoon of October 21. Physical examination: large erythematous and windy patches were seen on the head and trunk, and purple-black patches were seen all over the body, with rough skin and a small amount of scales. They were diffusely and symmetrically distributed. The patient’s symptoms disappeared that night after taking the medicine, and the original pigmented spots faded.