Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Urticarial dermatitis

Matthew J Zirwas, MD
Section Editor
Joseph Fowler, MD
Deputy Editor
Rosamaria Corona, MD, DSc


The term "urticarial dermatitis" describes an intensely pruritic, recalcitrant skin eruption characterized by erythematous papules and plaques that resemble urticaria but last longer than 24 hours and are sometimes accompanied by eczematous lesions [1]. Histologically, urticarial dermatitis is described by most pathologists as a "dermal hypersensitivity reaction," a nonspecific reaction pattern that is seen in a broad range of skin conditions, including drug reactions, scabies, and the prodromal phase of bullous pemphigoid [2]. However, in a subgroup of patients no underlying cause can be determined.


The incidence and prevalence of urticarial dermatitis are unknown. It occurs most frequently in individuals older than 50 years, with a slight female predominance [3,4].


The pathogenesis of urticarial dermatitis is incompletely understood. One hypothesis is that urticarial dermatitis is a lymphocyte mediated (type IV) hypersensitivity reaction. Clinical and histologic similarities have been noted between urticarial dermatitis and eruptions that occur in patients treated with anti-CTLA4 antibodies to break self-tolerance during immunotherapy for cancer [5]. This finding suggests that urticarial dermatitis may represent a waning of the regulatory function of the immune system that allows a reaction to develop against a self-antigen.


The pathologic features of urticarial dermatitis are nonspecific and include a normal stratum corneum, mild epidermal edema with minimal spongiosis, and a superficial to mid-dermal perivascular infiltrate of lymphocytes and eosinophils with occasional neutrophils (picture 1) [2]. A few basal apoptotic keratinocytes are sometimes present. Similar features may be seen in a variety of skin conditions, including drug reactions, arthropod assault, viral infections, and prodromal stage of bullous pemphigoid.


Patients with urticarial dermatitis typically present with an extremely pruritic, persistent eruption of dull red papules coalescing into plaques, associated with areas of urticated erythema, sometimes accompanied by eczematous lesions (picture 2C). In contrast with urticaria, lesions last for more than 24 hours and often for many days or weeks [1].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 01, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Kossard S, Hamann I, Wilkinson B. Defining urticarial dermatitis: a subset of dermal hypersensitivity reaction pattern. Arch Dermatol 2006; 142:29.
  2. Fung MA. The clinical and histopathologic spectrum of "dermal hypersensitivity reactions," a nonspecific histologic diagnosis that is not very useful in clinical practice, and the concept of a "dermal hypersensitivity reaction pattern". J Am Acad Dermatol 2002; 47:898.
  3. Hannon GR, Wetter DA, Gibson LE. Urticarial dermatitis: clinical features, diagnostic evaluation, and etiologic associations in a series of 146 patients at Mayo Clinic (2006-2012). J Am Acad Dermatol 2014; 70:263.
  4. Banan P, Butler G, Wu J. Retrospective chart review in a cohort of patients with urticarial dermatitis. Australas J Dermatol 2014; 55:137.
  5. Jaber SH, Cowen EW, Haworth LR, et al. Skin reactions in a subset of patients with stage IV melanoma treated with anti-cytotoxic T-lymphocyte antigen 4 monoclonal antibody as a single agent. Arch Dermatol 2006; 142:166.
  6. Virmani P, Chung E, Thomas AA, et al. Cutaneous adverse drug reaction associated with oral temozolomide presenting as dermal and subcutaneous plaques and nodules. JAAD Case Rep 2015; 1:286.
  7. Vu J, Ho J, English JC 3rd. Dermal hypersensitivity reaction as a prodrome to Hodgkin lymphoma. J Am Acad Dermatol 2010; 63:e13.
  8. Moon SY, Lee WJ, Lee SJ, et al. Urticarial dermatitis unresponsive to conventional treatment: a hidden sign of pancreatic cancer. Clin Exp Dermatol 2016; 41:322.
  9. Cotes ME, Swerlick RA. Practical guidelines for the use of steroid-sparing agents in the treatment of chronic pruritus. Dermatol Ther 2013; 26:120.
  10. Chaptini C, Sidhu S. Mycophenolate mofetil as a treatment for urticarial dermatitis. Australas J Dermatol 2014; 55:275.