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In dermatology practice, patients frequently present with a recalcitrant eruption distinguished by the presence of edematous, urticarial, intensely pruritic papules. After analysis of patient biopsy specimens, the dermatopathologist will often report a "dermal hypersensitivity reaction" (DHR) characterized by an eosinophil-rich infiltrate. The only clinical differentials that correspond to this pathologic diagnosis are arthropod bite and drug eruption, neither of which is clinically relevant to the present case.

This skin biopsy finding of DHR was described by Fung as "a histopathologic pattern for which corresponding clinical phenotypes have not been established."^1(p899) Fung's description of DHR (which he termed urticarial papulosis) is clinically and histologically identical to what was termed papular dermatitis by Clark et al² in 1998. Both studies comment on the difficulty of long-term control in affected patients.^1-2

This skin disease (herein referred to as "papular dermatitis") is not rare, and it is very challenging to treat. Affected patients . . . [Full Text of this Article]

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AUTHOR INFORMATION
Scott L. Flugman, MD