This file deals with rashes that are urticarial, i.e. composed of raised, red, relatively large, non-scaly plaques that persist more than 24 hours in any one spot. This last characteristic distinguishes them from urticaria.


In one study from the Mayo Clinic (JAAD Feb 2014), the most common diagnoses in patients who presented with an urticarial dermatitis (lesions present > 24 hours) were in approximate decreasing order urticaria, drug reaction; bullous pemphigoid; atopic dermatitis, contact dermatitis, PUPPP, scabies, CTCL, Schnitzlers syndrome and hypereosinophilic syndrome. Of note, 10% (4 of 40) had a newly diagnosed concurrent malignancy (within 4 months of UD onset).

Drug Reaction
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Hypersensitivity Reaction (I use the term HR here the same as drug reaction, but to non-prescriptions, e.g. supplements, vitamins)
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Urticarial Bullous pemphigoid Urticarial bullous pemphigoid.
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Urticarial Vasculitis
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Allergic Contact Dermatitis

Erythema Multiforme
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Scromboid Fish Poisoning

Still's disease
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Schnitzler syndrome Consider when the urticaria is chronic, unresponsive to treatment and is associated with bone pain, fever and/or neutrophilic urticaria histologically.


Serum sickness-like reaction
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Gianotti Crosti Syndrome
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Urticaria Multiforme

Very Rare

Autoimmune progesterone dermatitis

Cryopyrin Associated Periodic Syndromes, including Muckle-Wells Syndrome An urticaria-like eruption begins in infancy, progressive perceptive deafness, and amyloid nephropathy. The urticarial lesions are often accompanied by fever, arthralgias and limb pain.   A characteristic erysipelas rash may occur about the ankles.

Hyperimmunoglobulinemia D syndrome

Localized heat urticaria CED 1984;9;367

Langerhans cell histiocytosis JAAD 14;867

Chronic Recurrent Multifocal Osteomyeleitis JAAD April 2010 Volume 62, Issue 4, Pages 557–570

Intralymphatic Histiocytosis JAAD May 2014 Volume 70, Issue 5, Pages 927–933


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