Recurrent Facial Urticarial Lesions in Adolescent Female
Case at a Glance
A 16-year-old female presents with a 2-year history of recurrent, transient, itchy facial bumps that resolve spontaneously within hours if left untouched, but persist longer when scratched.
Patient's Story
The patient reports experiencing isolated, itchy bumps on her face for approximately 2 years. These lesions appear randomly and are initially pruritic for 10-15 minutes before the itching subsides. If the patient refrains from scratching, the bumps resolve completely within 1-2 hours. However, when scratched, the lesions persist for 1-2 days without associated pruritus. The patient denies any correlation with skincare products, as the bumps occur regardless of product use. She has tried multiple facial cleansers without improvement. The lesions respond partially to topical hydrocortisone cream. The patient is currently taking clonidine and escitalopram (Lexapro) and admits to occasional tobacco and cannabis use.
Initial Assessment
Physical examination revealed transient erythematous, raised lesions on the facial area consistent with urticarial wheals. The patient's vital signs were stable, and she appeared well-developed for her age at 5'5" and 100 lbs. No systemic signs of allergic reaction were observed.
The Diagnostic Journey
Given the transient nature, morphology, and response pattern of the lesions, differential diagnosis included contact dermatitis, insect bites, and urticaria. The patient's description of lesions appearing randomly without clear triggers, the characteristic wheal appearance, and the transient nature strongly suggested chronic idiopathic urticaria. The lack of systemic symptoms and the isolated facial distribution were noted.
Final Diagnosis
Chronic idiopathic urticaria with localized facial presentation
Treatment Plan
Patient education on avoiding scratching to prevent prolonged lesion duration. Continuation of topical hydrocortisone 1% cream as needed for symptomatic relief. Consider oral antihistamines (H1 receptor antagonists) for persistent episodes. Dermatology referral recommended for specialized evaluation and potential allergy testing to rule out specific triggers.
Outcome and Follow-up
Patient advised to maintain a symptom diary to identify potential triggers. Follow-up appointment scheduled in 4-6 weeks to assess response to treatment modifications. Long-term prognosis for chronic urticaria in adolescents is generally favorable with appropriate management.