Papular urticaria is a special form of hives that has been linked to the bites of a variety of insects and arachnids, including mosquitoes, fleas, and bedbugs. Not surprisingly, the problem is seasonal, generally occurring during the spring and summer, at the height of the bug season. It usually affects children between the ages of two and seven.

The eruption is marked by the appearance of waves of hivelike pimples ranging from one-eighth to one-half inch in diameter. The entire body may be affected, although most frequently lesions develop on the exposed areas of the face, neck, chest, backs of thighs, and buttocks. While some of the hives are found to possess a central prick mark, the site of an actual bite, the majority do not. The widespread nature of the eruption is believed to be an allergic reaction to only a few bites and is not the result of numerous bites all over.

In general, individual hives persist for between two to ten days, although occasionally the rash may persist for many weeks, even extending well beyond the end of the bug season. Recurrences are not uncommon, particularly in children with a personal or family history of atopy (asthma, seasonal rhinitis, or eczema).

The presence of seasonal, widespread, small-sized hives; a history of an exaggerated sensitivity to bug bites; and a personal or family history of atopy help to establish the diagnosis of papular urticaria. Preventive measures involve the same commonsense guidelines for avoiding biting and stinging insects described above. Treatment usually consists of the use of topical corticosteroid creams or lotions and oral antihistamines and corticosteroids.