Prognosis.—In the light form of urticaria the prognosis is very favorable. It suffices to remove the cause, and after a short time the formation of wheals ceases. It is more difficult, however, to effect a permanent cure of the chronic and persistent forms of urticaria.
Differential Diagnosis.—To establish a diagnosis is compara tively simple, as in children only lichen urticarius and erysipelas, or erythema, come in question. The differentiation from lichen will be given in detail in the section which treats of that disease. A confusion with erysipelas and erythema can only occur when urticaria covers large Batches of the face or entire parts of the body. The presence of fever will decide the question. In erythema again there is no sttch extensive swelling and rxiletna as in urticaria.
therapy endeavors in the first place to remove the existing harm and its cause. Should the cause be external, protection of the skin should be provided for, while an internal cause should be removed by laxatives and disinfectants so as to cleanse the intestine (calomel, rhubarb preparations, Carlsbad salts in olcler children; dis infectants: naphthalin, ichthyol and salicylate preparations). In frequently recurring urticaria long-continued use of Carlsbad or Marien bad waters is indicated. By regulation of the diet the intestine should be protected from all irritation. The intestine should be treated direct by irrigation or by washing the stomach.
The local treatment intends to relieve the itching by washing with cooling fluids in order to prevent the formation of new wheals. Thus, washing with thymol and menthol spirits, acetic water and citric water followed by- dusting the skin with talcum or amylum. Besides cooling
ointments with nienthol or carbolic acid (the doses for little children being quite weak); should be applied. In the majority of cases baths are exceedingly grateful in pruritus, although it happens here and there in children that the wheals increase in consequence of the hot tub. As additions to the bath I have found the following to be the best: soda baths (f to lbs. for a child's bath), or sulphur baths with Vlemingkx's solution (30 to 30 Gm. to a child's bath). Also baths of potassium per manganate (3 Gm. per bath) or bolus alba (I lb. to the bath) have a soothing effect. If the baths arc borne well, children will experience great relief by prolonging them. It goes without saying that nervous or hysterical complaints or disturbances in the general condition should be treated sirnultaneously, should such be present. To relieve excessive pruritus in older children, it is advisable to try weak doses of antipyrin and potassium bromide.
Urlicaria Factitia (dermographisme, dermatoneurosc stereograph Igoe, urticaria graphica, ete.).—Gull, in 1859, first described what Ite called ttrticaria factitia, being a vasomotor disturbance of the skin recognized long ago. It consists of straight, whealy, white pimples which appear upon the skin on external irritation (scratching, finger nails), they have a red margin and persist for a shorter or longer period. The trouble is mostly met with in persons with a nervous disposition, especially in hy-sterical patients. It is not very frequent in children. Barth616my has described it occurring in children of three, five, six and eight years, calling attention to the fact that heredity seems to exert a certain influence.