What is acne urticata?
Acne urticata is a term that is not often used today. It describes very itchy papules or prurigo (itchy spots) that affects the face, neck and cape area (upper trunk and upper arms). It is not actually acne.
It is not clear whether acne urticata is a unique disorder. Lesions described as acne urticata may be a localised form of compulsive skin picking. Others confined to sun exposed sites are likely a form polymorphous light eruption.
Who gets acne urticata?
Acne urticata is most often described in middle-aged women that are suffering some form of stress and anxiety.
What causes acne urticata?
The cause of acne urticata is not understood. It may be due to an innate immune reaction within the hair follicle, resulting in the production of pruritogenic substances, a neuropathic form of pruritus (itch), or psychogenic in origin.
Although women with acne urticata are often under stress, it is hard to know whether the stress precedes the rash or whether the stress is caused by the rash's itchiness.
What are the clinical features of acne urticata?
In acne urticata, small bumps (papules), blisters (vesicles) and pustules arise in the "cape" area of the body, ie the face, scalp, neck, upper arms and upper trunk. They are so intensely itchy that they are rapidly scratched or picked. This leaves unsightly, crusted lesions, which may then leave permanent small white scars.
What is the treatment for acne urticata?
Acne urticata is difficult to treat effectively and may persist for years. The following may be useful:
- Topical corticosteroids
- Long courses of oral antibiotics, usually a tetracycline
- Ultraviolet treatment (phototherapy). This is not suitable if the papules are provoked by exposure to light.
- Tricyclic antidepressants, such as amitriptyline, which can reduce itch sensations in the skin
- Anti-inflammatory agents such as methotrexate
- Behavioural therapy to reduce skin picking