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VisualDx Reminds Derm Resident What to Look for to Confirm Patient's Rash

urticariapigmentosa_darier_sign_2726.jpgJasmine, a dermatology resident at Stanford University, shares how VisualDx confirmed her young patient's diagnosis.

"I was concerned about urticaria pigmentosa in a 3-4 yo female patient and reading through VisualDx summary on this topic reminded me to do Darier's sign, which was positive for my patient! Also reminded me to do a full review of systems."

Urticaria pigmentosa pictured here is not the patient in this case study. See more pictures of urticaria pigmentosa in VisualDx.

What is urticaria pigmentosa?

Urticaria pigmentosa is the most common cutaneous mastocytosis in children. Mast cells accumulate in the skin, causing characteristic pruritic skin lesions. It causes generalized, persistent, pigmented lesions that urticate or wheal with any mechanical stimuli.

What to look for

  • Erythematous to brown patches that become urticarial or blister upon rubbing or scratching (Darier sign)
  • Lesions can be few or numerous and typically involve the trunk.
  • Lesions are usually 1-2 cm.
  • Lesions can have a peau d'orange appearance.

How can we treat this?

Urticaria pigmentosa can be managed by avoiding triggers which commonly include medications, physical stimuli, and foods.

Treatment can include oral antihistamines if the patient is symptomatic and topical steroids under occlusion may reduce skin lesion severity.

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About VisualDx

VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,500 hospitals and institutions nationwide.  VisualDx combines clinical search with the world's best medical image library, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across General Medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at