Treatment options include antihistamines, corticosteroids, PUVA
Patients with UP should be instructed to avoid precipitating factors such as temperature changes, friction, alcohol ingestion, aspirin, physical exertion, or opiates. Treatment options include H1 and H2 antihistamines, cromolyn sodium, topical corticosteroids, and PUVA (psoralen plus ultraviolet A photochemotherapy).3 PUVA is normally avoided in pediatric patients because it is associated with an increased risk of skin cancer later in life.12
Our patient. We prescribed a topical corticosteroid, 0.05% betamethasone dipropionate cream, and oral cromolyn sodium 100 mg qid for our patient, but this failed to significantly improve the macules. The patient and parents grew increasingly anxious. Ultimately, the parents decided to have their daughter treated with PUVA in limited amounts. Topical psoralen was also used. After 2 months of treatment, the patient’s lesions substantially improved and many of them disappeared. In addition, the parents were educated on the importance of sunscreen and limiting their daughter’s exposure to the sun, when possible.
THE TAKEAWAY
UP can be diagnosed by taking a thorough history and conducting a physical examination; a skin biopsy that reveals increased mast cells will confirm the diagnosis. UP is usually self-limited and resolves in about one-half of patients by puberty. Treatment options include H1 and H2 antihistamines, cromolyn sodium, topical corticosteroids, and PUVA. Patients should be referred to a specialist if their symptoms become severe, systemic UP is suspected, or they do not respond to therapy.