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REVIEW ARTICLES: Kara N. Shah, Paul J. Honig, and Albert C. Yan "Urticaria Multiforme": A Case Series and Review of Acute Annular Urticarial Hypersensitivity Syndromes in Children Pediatrics 2007; 119: e1177-e1183 [Abstract] [Full text] [PDF]

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A timely submission

Mark W Shen, M.D.   (2 May 2007)

A more appropriate term is necessary for "urticaria multiforme"

Alexander C. Katoulis, MD, Panayiota Biskini, MD, and Evangelia Bozi, MD.   (31 March 2008)

A timely submission 2 May 2007
Mark W Shen, M.D., Assistant Professor of Pediatrics UT Southwestern Medical Center Send letter to journal: Re: A timely submission mark.shen{at}childrens.com Mark W Shen, M.D.	I applaud the authors' summary and review of their experience with "urticaria multiforme." It is extremely timely as our hospitalist group in Dallas, Texas cared for 2 cases in the final week of April, 2007. Prominent acral edema and erythema prompted admission from the emergency room for concerns of Kawasaki disease. Although the children did not fit that syndrome, other vaculitic and hypersensitivity-type reactions were discussed. In one case, annular and polycyclic lesions resulted in a discharge diagnosis of erythema multiforme. In the arena of medicine, sometimes the less you know, the more you do. Without descriptive reviews such as this by Shah et al, clinical decisions are often based on limited information. In the case of a mistaken discharge diagnosis of erythema multiforme, the issue is perhaps semantic. Yet with regards to hospital admission, the knowledge provided by this review may prove the opposite of the above statement to be true: sometimes the more you know, the less you do. REFERENCES Kara N. Shah, Paul J. Honig, and Albert C. Yan "Urticaria Multiforme": A Case Series and Review of Acute Annular Urticarial Hypersensitivity Syndromes in Children Pediatrics 2007; 0: peds.2006-1553v1-1183 Conflict of Interest: None declared
A more appropriate term is necessary for "urticaria multiforme" 31 March 2008
Alexander C. Katoulis, MD, Instructor in Dermatology and Venereology National University of Athens, Medical School, Athens, Greece, Panayiota Biskini, MD, and Evangelia Bozi, MD. Send letter to journal: Re: A more appropriate term is necessary for "urticaria multiforme" alexanderkatoulis{at}yahoo.co.uk Alexander C. Katoulis, MD, et al.	In an excellent recently published article, Shah et al described a clinical variant of acute urticaria seen in children and characterized by annular or polycyclic urticarial lesions, dermatographism, angioedema, favorable response to antihistamines and, occasionally, modest elevation in acute phase reactants [1]. This entity termed "urticaria multiforme" is often confused and should be differentiated, most importantly, from erythema multiforme and serum sickness-like reactions, conditions with completely different pathogenesis, prognosis and treatment. Although acute annular urticaria is a common and well known subtype of urticaria in children, the distinction of "urticaria multiforme" is very helpfull in terms of diagnosis and treatment. Recently, a 4 and a half- month-old female was referred to us with atypical target lesions of the lowers legs and feet, fever (up to 38.5īC) and a history of vomitting and diarrhea 2 days before. The initial diagnosis of the skin rash was erythema multiforme. Extensive laboratory work up revealed leukocytosis and an E. coli urinary infection. Treatment with antihistamines resulted in rapid, within 48 hours, clearance of the rash. On this basis, the diagnosis of urticaria multiforme was established. However, the term "urticaria multiforme" selected by the authors is misleading. The adjective "multiforme" is of latin origin and reffers to someone/something presenting in many forms. This is absolutely true for erythema multiforme, in which skin lesions can appear as macules, papules, urticarial plaques, most often with concentric rings of edema, erythema, and a purpuric or necrotic or bullous centre. These target or iris-like lesions are the hallmark of erythema multiforme [2]. Nevertheless, in the same patient the skin rash is monomorphous. In the case of urticaria multiforme, there is no such clinical variety and, obviously, what the authors tried to point out was the clinical similarities with erythema multiforme. Therefore, a more appropriate term would be "erythema multiforme - like urticaria" or "urticaria with targetoid lesions" or whatever else the authors propose, but certainly not "urticaria multiforme". References 1.Shah KN, Honig PJ, Yan AC. "Urticaria Multiforme": A Case Series and Review of Acute Annular Urticarial Hypersensitivity Syndromes in Children.Pediatrics 2007;119:e1177-e1183. 2. Assier H, Bastuji-Garin S, Revuz J, Roujeau JC. Erythema multiforme with mucous membrane involvement and Stevens-Johnson syndrome are clinically different disorders with distinct causes. Arch Dermatol 1995;131:539-43. Conflict of Interest: None declared