Urticaria pigmentosa is a skin disease that produces patches of darker skin and very bad itching. Hives can develop when these skin areas are rubbed.
Urticaria pigmentosa occurs when there are too many inflammatory cells (mast cells) in the skin. Mast cells are immune system cells that help the body fight infections. Mast cells make and release histamine, which causes nearby tissues to become swollen and inflamed.
Things that can trigger histamine release and skin symptoms include:
- Rubbing the skin
- Drinking hot liquids, eating spicy food
- Sunlight, exposure to cold
- Medicines, such as aspirin or other NSAIDs, codeine, morphine, x-ray dye, some anesthesia medicines, alcohol
Urticaria pigmentosa is most common in children. It can also occur in adults.
The main symptom is brownish patches on the skin. These patches contain cells called mastocytes. When mastocytes release the chemical histamine, the patches develop into hive-like bumps. Younger children may develop a blister that is filled with fluid if the bump is scratched.
The face may also get red quickly.
In severe cases, these symptoms may occur:
- Fainting (uncommon)
- Rapid heartbeat
Exams and Tests
The health care provider will examine the skin. The provider may suspect urticarial pigmentosa when the skin patches are rubbed and raised bumps (hives) develop. This is called the Darier sign.
Tests to check for this condition are:
- Skin biopsy to look for a higher number of mast cells
- Urine histamine
- Blood tests for blood cell counts and blood tryptase levels (tryptase is an enzyme found in mast cells)
Antihistamine medicines can help relieve symptoms such as itching and flushing. Talk to your provider about which type of antihistamine to use. Corticosteroids applied on the skin and light therapy can also be used in some cases.
Your provider may prescribe other kinds of medicine to treat symptoms of severe and unusual forms of urticaria pigmentosa.
Urticaria pigmentosa goes away by puberty in about one half of affected children. Symptoms usually get better in others as they grow into adulthood.
In adults, urticaria pigmentosa can lead to systemic mastocytosis. This is a serious condition that can affect bones, the brain, nerves, and the digestive system.
The main problems are discomfort from itching and concern about the appearance of the spots. Other problems such as diarrhea and fainting are rare.
Insect stings may also cause a bad allergic reaction in people with urticaria pigmentosa. Ask your provider if you should carry an epinephrine kit to use if you get a bee sting.
When to Contact a Medical Professional
Call your provider if you notice symptoms of urticaria pigmentosa.
Chapman MS. Urticaria. In: Habif TP, Dinulos JGH, Chapman MS, Zug KA, eds. Skin Disease: Diagnosis and Treatment. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 3.
Chen D, George TI. Mastocytosis. In: Hsi ED, ed. Hematopathology. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 20.
Paige DG, Wakelin SH. Skin disease. In: Kumar P, Clark M, eds. Kumar and Clarke's Clinical Medicine. 9th ed. Philadelphia, PA: Elsevier; 2017:chap 31.
Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.