Salalah eruption: Regional variant of papular urticaria

Abstract

Background Papular urticaria is hypersensitivity reaction to bites from various insects viz. mosquitoes, fleas, gnats, mites, bed bugs, caterpillars, and moths. Few of them may be too small to be visible to unaided eye. Mosquitoes are commonly incriminated in south Asia, while fleas are common in San Francisco. Antigen deposited during bite is disseminated haematogenously leading to reaction in sensitive patients. Extremely hot, climate and scarce rains in Middle Eastern countries makes it a hostile environment for insects to breed. Salalah, to the south-east of Oman enjoys plenty of rains during autumn, which makes for a popular tourist destination during this period. Several returning tourists present with itchy rash, popularly known as “Salalah eruption” among the locals. Methods We observed the clinical characteristics of “Salalah eruption” over a period of 4 years and present our findings. Results Of the 68 cases, males (52.94%) constituted more than females in the study population. Pruritic rash was most common complaint while limbs were the most often affected. The suspected insect was identified as biting midge. Conclusion Some areas in arid land may receive rains and provide breeding grounds for insects. We present a study of 68 cases presenting as “Salalah eruption”. Physicians inexperienced with papular urticaria may find it challenging to identify and deal with this condition as it is unexpected in this geographic area. Also it is extremely important to identify the culprit insect, which may be a vector, so as to expect any transmissible disease(s) through these bites if any.