ABSTRACT
The definition of papular urticaria varies with the clinician, since its original description by Bateman in 1813 (1). It is of interest that the most recent additions of Rook, Andrews, and Fitzpatrick do not list papular urticaria in the index. The numerous synonyms do appear in various formats (Table I). The many synonyms attest to the variety of so-called questionable etiologies that, in a more genteel time, were an important disguise of symptoms related to less "desirable" causes (i.e., arthropods). For many clinicians the diagnosis of papular urticaria translated into what appeared to be unclean habits (lice, scabies, insect bites) and this was often difficult for the patient to accept. Indeed while we use the clinical pattern in supporting such a diagnosis, the science behind it was and still is significantly lacking. A reaction to various proteins in insect venom and secretions was thought to be the primary mechanism.
