Indian Journal of Paediatric Dermatology

LETTER TO EDITOR
Year
: 2019  |  Volume : 20  |  Issue : 4  |  Page : 351-

Use of oral ketotifen and vitamin D in the management of papular urticaria


Ashimav Deb Sharma 
 Dermacare Clinic, Bongaigaon, Assam, India

Correspondence Address:
Dr Ashimav Deb Sharma
Dermacare Clinic, Bongaigaon - 783 380, Assam
India




How to cite this article:
Sharma AD. Use of oral ketotifen and vitamin D in the management of papular urticaria.Indian J Paediatr Dermatol 2019;20:351-351


How to cite this URL:
Sharma AD. Use of oral ketotifen and vitamin D in the management of papular urticaria. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Dec 10 ];20:351-351
Available from: http://www.ijpd.in/text.asp?2019/20/4/351/268394


Full Text



Papular urticaria (PU) is a common and annoying disorder, which develops because of a hypersensitivity reaction to insect bites such as fleas, bed bugs, mosquito, mites, spiders, ticks, and caterpillars. PU commonly affects children in the age group of 2–10 years and occasionally in adolescents and adults. The prevalence rate in schoolchildren is found to be 5.27% in an Indian study.[1] It is caused by both Type 1 and 4 hypersensitivity reaction.[2] Sensitization takes time to cause PU; hence, it is uncommon in newborns. Higher prevalence in children may result from immune mechanisms and/or behaviors predisposing them to contact with insects. Children eventually outgrow the disease due to desensitization after multiple exposures. There are no racial or gender predilections. The disease is common in summer and spring seasons when opportunities of bites are more.

Management of PU consists of the use of topical steroid with or without antibiotic, oral antihistaminic, covering of exposed skin, and the use of insect repellents. However, the outcome of treatment is not satisfactory as the remission is short-lived in most of the cases. One of the reasons for this is that PU has an association with atopy. About 70% of individuals with PU are atopic.[2] Atopic individuals have a persistent T-h2 response, which make them more vulnerable for pruritus and eczematization.[3],[4],[5]

One small study was undertaken to see the benefit of oral Ketotifen and Vitamin D over conventional therapy in the management of PU. Ketotifen is a second-generation noncompetitive H1-antihistamine and mast cell stabilizer. Due to its action on mast cell, it is more effective in atopic allergy. Vitamin D has significant effects on both adaptive and innate immunity through Vitamin D receptors. It can affect T-cell activation and antigen-presenting cells function and can down-regulate allergy.

A total of 19 patients (males: 9; females: 10; age group: 6–13 years; mean age: 8.3 years) with PU with raised total serum IgE level were included in the study. Patients were advised to use the following treatments for 6 weeks:

Topical steroid with antibiotic: To be applied 2–3 times a dayVitamin D: 600 i.u. daily for 6 weeksKetotifen: 1–1.5 mg/day for 4 weeks and then 0.5 mg for another 2 weeksCovering of exposed skin.

Patients were evaluated at 3 weeks interval for 3 months. Results of the treatment were very interesting. All the patients were free from itching by the end of 3 week and this improvement was maintained until the end of 3 months. Partial reduction in the size of the skin lesions was noted in all participants at the end of 3 weeks. Complete reduction of skin lesions was noted in 12 patients at 6 weeks. At 3 months, another three patients had complete reduction in the size of skin lesions; however, pigmentation persisted in all patients. Only side effect noted was mild-to-moderate drowsiness experienced by few patients at the beginning of the treatment.

The author concluded that a combination of oral Ketotifen and Vitamin D in the management of PU could bring a faster and longer remission in the patients. A multicenter study comprising large number of patients with longer follow-up will be more informative.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Karthikeyan K, Thappa DM, Jeevankumar B. Pattern of pediatric dermatoses in a referral center in South India. Indian Pediatr 2004;41:373-7.
2Thomas J, Ravi D. Papular urticaria: A known early indicator of atopic dermatitis. ARC J Dermatol 2017;2:16-7.
3Neaville WA, Tisler C, Bhattacharya A, Anklam K, Gilbertson-White S, Hamilton R, et al. Developmental cytokine response profiles and the clinical and immunologic expression of atopy during the year of life. J Allergy Clin Immunol 2003;112:740-6.
4Yabuhara A, Macaubas C, Prescott SL, Venaille TJ, Holt BJ, Habre W, et al. TH2-polarized immunological memory to inhalant allergens in atopics is established during infancy and early childhood. Clin Exp Allergy 1997;27:1261-9.
5Cuéllar A, García E, Rodríguez A, Halpert E, Gómez A. Functional dysregulation of dendritic cells in patients with papular urticaria caused by fleabite. Arch Dermatol 2007;143:1415-9.