“Urticaria Multiforme”: A Case Series and Review of Acute Annular Urticarial Hypersensitivity Syndromes in Children

Abstract

Acute annular urticaria is a common and benign cutaneous hypersensitivity reaction seen in children that manifests with characteristic annular, arcuate, and polycyclic urticarial lesions in association with acral edema. It is mistaken most often for erythema multiforme and, occasionally, for a serum-sickness-like reaction. Although these 3 entities may present in a similar manner, specific clinical features help to distinguish them, and it is important for the clinician to be able to differentiate among them. We present herein a series of 18 patients who were given a diagnosis of acute annular urticaria and review the clinical distinctions between acute annular urticaria, serum-sickness-like reactions, and erythema multiforme. Because of the frequency of its clinical confusion with erythema multiforme, we propose the term "urticaria multiforme" as a more apt description to highlight the distinctive clinical features of this urticaria variant.

Two Young Children with Rashes on Their Trunk and Extremities

“…Urticaria, however, is a self-limiting symptom that responds well to treatment with antihistamines. 2 The term "acute annular urticarial" was first introduced in 1997; 3 and the term "urticaria multiforme" was introduced in 2007. 2 Both terms describe this special form of urticaria that is characterized by the acute onset of annular wheals with a pale or ecchymotic center.…”

“…2 The term "acute annular urticarial" was first introduced in 1997; 3 and the term "urticaria multiforme" was introduced in 2007. 2 Both terms describe this special form of urticaria that is characterized by the acute onset of annular wheals with a pale or ecchymotic center. Infections are the main cause of the symptoms (as seen in the two cases presented here), but sometimes they are triggered by antibiotics or food allergies.…”

A case series of urticaria multiforme: Its association with Mycoplasma pneumoniae infection?

“…Ürtikerya multiforme; nadir görülen, çocukluk çağında ortaya çıkan, akut ürtikerin klinik ve morfolojik bir alt tipi olarak tanımlanan, benin kutanöz bir hipersensitivite reaksiyonudur. Ürtikerya multiforme tablosunda, akut olarak başlayan, basmakla solan, anüler, polisiklik şekilde, koyu renkli veya ekimotik merkezi olan eritematöz kabarıklıklar ("hedef" benzeri lezyonlar) görülür ve olguların tamamına yakınında kaşıntı, yaklaşık yarısında ise dermatografizm ve/veya yüz, el ve ayaklarda ödem bulunur 2,3 . Ürtikerya multiforme, özellikle eritema multiforme ve daha seyrek olarak da serum hastalığı benzeri reaksiyon gibi patogenezi, tedavisi ve prognozu farklı diğer anüler deri hastalıkları ile karıştırılabilen ve/veya tanısı sıklıkla gözden kaçırılabilen bir hastalıktır.…”

“…Ürtikerya multiforme tanısı alan olguların çoğunda enfeksiyonlar (viral veya bakteriyel) ve ilaç kullanma öyküsü bulunduğu bildirilmekle birlikte hastalığın etyolojisi ve patogenezi hakkındaki bilgiler sınırlıdır. Literatürde "akut anüler ürtiker" veya "ürtikerya multiforme" hakkında, çoğu olgu sunumlarından oluşan az sayıda yayın bulunmaktadır [2][3][4][5][6][7][8] . Ek olarak ürtikerya multiforme ve Mycoplasma pneumoniae infeksiyonu birlikteliği oldukça nadirdir, literatürde sadece iki olguda bildirilmiştir 2,8 .…”

Immunopathological aspects of oral erythema multiforme

“…12 Administration of oral corticosteroids, especially after the second to fourth days will decrease the eruption period of acute symptoms. On minor type, oral corticosteroids were given 20-40 mg/day for 4-6 days in tapering dose not more than two weeks.…”