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Abstract: This article refers to a 3-year-old child who came to the clinic with a red papular rash on his skin. The child followed his parents on a trekking trip 3 days ago, and when he returned, he noticed that he had bumps on his arms and legs similar to mosquito bites. He was diagnosed with papular urticaria by the child’s physical signs and auxiliary examination, and the rash subsided and the itching subsided after medication was given.
Basic information】Male, 3 years old
Disease Type】Papular urticaria
Hospital】Tianjin Haihe Hospital
Date of consultation】June 2019
Treatment Plan】Topical medication (Furamyl lotion, hydrocortisone butyrate cream, mupirocin ointment) + oral medication (cetirizine hydrochloride drops)
[Treatment period] 1 week of outpatient medication, follow-up after 6 months
Treatment effect】Rash subsided, itching relieved
I. Initial consultation
One day in early summer, a mother brought her child to the clinic. The child had a lot of red papules on his body, and the itching was obvious. The mother said that three days ago the child followed her family on a trip to the greenery, and when she returned home, she found a few bags on her arms and legs that resembled mosquito bites, so she didn’t pay much attention to them at first and applied flower lotion. But the next day found that the child’s body “mosquito bag” more, and very itchy, and sleep at night is not solid. The child’s mother then took it seriously and brought the child to the clinic. Specialized examination showed that the child’s exposed areas of the limbs were scattered with red papules of soybean size, slightly spindle-shaped, with clear borders and consistent morphology, and some of the rashes had small blisters at the top. The routine blood test indicated that the eosinophils were slightly high, and the biochemical tests were not significantly abnormal.
II. Treatment history
After the diagnosis was clear, the first task was to stop the itch as soon as possible and avoid scratching, so the prescription was based on topical medication in order to act directly on the affected area and accelerate the effect. In lieu of scratching, furnace glycolate lotion was given to relieve swelling and itchiness on a daily basis; hydrocortisone butyrate cream was applied to the affected area morning and evening to relieve itchiness for a long time. For rashes that have broken down, attention was paid to prevent secondary infection by using mupirocin ointment as an anti-inflammatory and anti-infective agent. At the time of consultation, the child’s sleep was already affected by itching, so oral anti-allergy drug cetirizine hydrochloride drops for children were given at the beginning of treatment. 3 days later, the itching symptoms were significantly relieved, the oral anti-allergy drug was discontinued, and the topical medication was continued and changed to hydrocortisone butyrate cream. The whole treatment cycle was 1 week, and the follow-up mainly relied on skin self-recovery.
III. Treatment effect
After 1 week, except for a few crusts which needed time to fall off by themselves, most of the rash areas only left light brown post-inflammatory pigmentation, which was caused by the intense local inflammatory reaction and scratching damage to the skin. Over time, the hyperpigmentation will slowly fade away on its own with skin metabolism. At the follow-up visit after six months, the mother indicated that the child’s skin was intact as before.
Precautions
I was very happy that the child’s skin had healed as before through medication. In addition to medication, the mother should pay attention to the child’s personal hygiene and environmental hygiene, pay attention to local skin cleanliness, avoid water or bathing during the treatment period, and choose soft, clean and dry clothes and bedding for the child; you can use a safe, harmless insecticide spray to eliminate bedbugs, mosquitoes, fleas, mites, lice and other insects in the environment to avoid insect bites and aggravate skin symptoms. Remember to disinfect the child’s toys to avoid skin infections caused by bacteria. When the child is itchy, scratching is strictly prohibited, you can first apply a cold towel and apply the medication prescribed to the child, which can relieve the symptoms of itching. During the treatment period, it is advisable to have a light diet, drink more water, avoid spicy stimulating and allergenic foods, ensure sufficient sleep and maintain a normal rest and relaxation routine. After the rash subsides, pay attention to skin moisturization and apply body lotion daily to promote the recovery of skin barrier.
V. Personal insight
Papular urticaria occurs in spring, summer and autumn, mostly in infants and children. These children cannot fully understand and follow medical advice, and inevitably scratch the rash when itching, which can easily lead to rash aggravation, rupture and infection. Therefore, the first priority in treatment must be to stop the itching. If necessary, safe anti-allergy drugs for children can be chosen for oral use, together with medium- and weak-effect glucocorticoid creams for short-term treatment, in order to achieve rapid anti-itch and anti-allergy purposes. Papular urticaria is a delayed allergic reaction, and children with allergies or other allergy-related diseases should be especially careful to avoid the associated risk factors.