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Last Updated on November 17, 2023

Urticaria Multiforme (UM), a rare but perplexing skin condition, presents a challenging puzzle for patients and healthcare professionals. Unlike the more common urticaria (hives) that many people are familiar with, the condition showcases a distinctive set of clinical characteristics that set it apart. However, in this comprehensive exploration, we will investigate the clinical presentation of this type of urticaria, from its defining features to its causes and management.

What is Urticaria Multiforme?

Urticaria Multiforme, or Urticarial Dermatitis, is a rare and distinctive skin disorder. While its exact prevalence is uncertain, it is significantly less common than its close relative, Urticaria. However, this condition’s clinical presentation marks various distinctive characteristics that healthcare professionals carefully examine when diagnosing and managing patients.


The clinical presentation of this kind of Urticaria can vary significantly from one individual to another. However, some common symptoms and characteristics often manifest

Wheals and Lesions

This kind of Urticaria typically presents with urticarial wheals, which are raised, red, and itchy welts on the skin. Moreover, these wheals can vary in size and shape, creating a mosaic-like appearance.

Target or Bullseye Lesions

One of the hallmark features of UM is the development of target or bullseye lesions. However, these lesions have a central red spot surrounded by a pale ring and an outer red ring resembling a target. These lesions are often seen on the trunk and extremities.

Itching and Burning Sensation

Patients commonly report intense itching and burning sensations because of the skin lesions. Nevertheless, this can lead to considerable discomfort.

Oral and Genital Involvement

Urticaria Multiforme can affect mucous membranes, leading to painful sores in the mouth and genital areas. Moreover, these lesions are often known as aphthous ulcers or erosions.

Fever and Malaise

Some patients with this condition experience flu-like symptoms, including fever and malaise, which can be debilitating.

Acral Swelling

Swelling of the hands and feet, known as acral swelling, is another characteristic feature of this condition.

Urticaria Multiforme Causes and Triggers

The etiology of this condition remains unclear, and it is considered an idiopathic condition, meaning the exact cause is often unknown. However, various triggers and associations have been identified, including:


In some cases, Urticaria Multiforme occurs due to infections, such as viral or bacterial infections. However, common culprits include herpes simplex virus, Mycoplasma pneumonia, and Epstein-Barr virus.


Certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and antiepileptic drugs, have been associated with UM.

Autoimmune Factors

There is evidence to suggest that autoimmune mechanisms may play a role in Urticaria, although the precise mechanisms are not fully understood.

Genetic Predisposition

Some individuals may have a genetic predisposition to developing UM.

Diagnosis and Differential Diagnosis

Diagnosing this Urticaria type can be challenging due to its unique clinical presentation. However, healthcare professionals typically follow a systematic approach to reach a diagnosis, which includes

Clinical Assessment

A thorough physical examination is conducted to identify the characteristic wheals, target lesions, and other associated symptoms.

Patient History

The patient’s medical history, including recent infections, medication use, and previous episodes of Urticaria Multiforme, is crucial for diagnosis.

Skin Biopsy

Sometimes, a skin biopsy may be performed to confirm the diagnosis and rule out other skin conditions.

Laboratory Tests

Blood tests may assess underlying infections or autoimmune factors.

Differential Diagnosis

The condition must differ from other conditions with similar clinical presentations, such as Stevens-Johnson Syndrome, erythema multiforme, and urticarial vasculitis.

Management and Urticaria Multiforme Treatment

Urticaria management focuses on relieving symptoms, identifying and addressing underlying triggers, and preventing recurrence. Moreover, the treatment approach may include


Non-sedating antihistamines are commonly prescribed to alleviate the itching and discomfort that follows this disease.


In more severe cases, oral or topical corticosteroids may be prescribed to reduce inflammation and suppress the immune response.

Treatment of Underlying Infections

The doctor may suggest an antibiotic if he identifies an infection as the cause.

Pain Relief

Managing the discomfort caused by oral and genital ulcers may require pain relievers.

Avoiding Triggers

Identifying and avoiding triggers, such as specific medications, is a critical aspect of managing this condition.

Urticaria Multiforme Research: Recent Developments

The growing recognition of Urticaria as a unique condition spurs intensive research efforts — Nevertheless, these efforts lead to several significant developments.

Immunological Insights

Recent research has shed light on the role of the immune system in Urticaria Multiforme. However, it is increasingly seen as an immune-mediated condition, possibly a cause of autoimmune mechanisms.

Genetic Associations

Studies indicate that there may be genetic predispositions to this kind of Urticaria in some individuals. Moreover, genetic research is ongoing to unravel gene involvement.

Infections Causing Triggers

In some instances, this Urticaria type appears to cause viral or bacterial infections, such as herpes simplex virus, Mycoplasma pneumonia, or Epstein-Barr virus. However, researchers are investigating the links between other skin conditions and Urticaria Multiforme.

Clinical Subtypes

Researchers are exploring the possibility of distinct clinical subtypes of this condition, each with unique characteristics and triggers.

Quality of Life Studies

Beyond the clinical aspects, studies focus on the impact of Urticaria Multiforme on a patient’s quality of life, considering the psychological and emotional factors of the condition.

Emerging Urticaria Multiforme Treatment

While the treatment of Urticaria Multiforme traditionally centers on managing symptoms, emerging treatments offer new hope for more effective and targeted therapies. Here are some of the promising developments in this regard

Biological Therapies

Monoclonal antibodies, a class of drugs known for their precision in targeting specific molecules, are under observation to treat this condition. However, these antibodies target immune pathways involved in the condition, potentially providing long-lasting relief.


Immunomodulatory drugs are under consideration to modulate the immune response in this condition. Nonetheless, this approach aims to restore immune balance and reduce the frequency and severity of outbreaks.

Anti-Inflammatory Agents

Inflammation plays a significant role in developing wheals and lesions in this urticaria kind. Anti-inflammatory agents are under study for their potential to alleviate symptoms and prevent recurrences.

Genetic-Based Therapies

With the discovery of genetic associations, there’s potential for personalized treatments unique to an individual’s genetic profile. This could lead to more effective and targeted therapies.

Infection Management

Research continues into the relationship between Urticaria and infections. However, understanding these connections may lead to better strategies for managing and preventing the condition in infection-triggered cases.

Patient-Centered Care

Emerging treatments also encompass a holistic approach considering the patient’s emotional and psychological well-being. Treatment plans also include psychotherapy, support groups, and stress management techniques.

Challenges and Future Directions

Despite the promising strides in Urticaria Multiforme research and emerging treatments, challenges remain. These challenges include


This Urticaria type presents with a wide range of clinical presentations, making it challenging to develop one-size-fits-all treatments. Moreover, personalized medicine approaches are essential to address this heterogeneity.

Long-Term Outcomes

The long-term outcomes of emerging treatments are still under investigation. However, ensuring their safety and effectiveness over extended periods is crucial.

Treatment Accessibility

Some emerging treatments may be costly or limited in availability. Furthermore, ensuring equitable access to these therapies for all patients is a priority.

Recurrence Prevention

Preventing recurrent episodes of Urticaria Multiforme remains a significant challenge, and research in this area is ongoing.

Psychological Support

While there is a growing recognition of the psychological impact of the condition, integrating mental health support into treatment plans is an ongoing process.


This kind of Urticaria presents a unique clinical puzzle in dermatology. Its distinctive wheals, target lesions, and following symptoms can perplex patients and healthcare professionals. While the exact cause remains elusive, understanding the clinical presentation and triggers that relate to this condition is vital for accurate diagnosis and effective management.

By understanding the symptoms, urticaria multiforme causes, diagnosis, and management of this condition, we can shed light on this rare but intriguing skin disorder, providing valuable information for both those affected by it and the medical community striving to understand better and treat this condition.


MetroBoston Clinical Partners is a well established and experienced research center in the greater Boston area. Under the leadership of qualified physicians and medical professionals, we coordinate a range of clinical research trials in Dermatology and Internal Medicine.

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