An 18-Month-Old with an Itchy Rash and Wheezing

Differential Diagnosis

• Urticaria pigmentosa
• Bullous impetigo
• Atopic dermatitis
• Psoriasis

Diagnosis

This patient was diagnosed with urticaria pigmentosa, a form of cutaneous mastocytosis in which mast cells accumulate in the skin, causing the characteristic skin lesions seen here.

 

Learnings

• Urticaria pigmentosa presents within the first week-to-months of life, though involution can occur in early childhood or last until puberty
• Bronchospasm, as well as flushing, diarrhea, and syncope can all occur
• Unlike adult forms of mastocytosis, there is rarely internal organ involvement in children

 

Pearls for Urgent Care Management and Considerations for Transfer

• There is no “cure,” per se, for urticaria pigmentosa, though antihistamines can relieve itching and flushing. Other treatments include:
  • Topical corticosteroids
  • Hydrocolloid dressings
  • Fluocinolone acetenoide
• Parents of younger children should try to discourage scratching or rubbing of itchy skin, as doing so could spur a stronger reaction

 

Acknowledgment: Images courtesy of VisualDx.