Papular urticaria is a form of urticaria common in infancy and early childhood. The incidence is so high that it is scarcely logical to describe it as a disease, though this is usually done. The current theories of causation are notoriously inadequate, and invariably ignore the chief feature of the condition, namely the compulsive scratching which is not entirely secondary.
In this communication it is suggested that the skin of infants must be regarded as an excitable organ, and that papular urticara is simply a skin excitement, an erection. Excitement can be brought about by external causes—unsuitable clothing, infestation, etc., and by internal causes—the hands have a function here, as in genital masturbation. In troublesome cases these internal causes are themselves complicated in various ways and degrees, and may indicate that the child is having difficulties in regard to anal or genital excitement, and the accompanying unconscious phantasies. When papular urticaria is met with as a distressing disease, the skin has become the site of a battle that is analogous to the battle over anal or genital masturbation.
It is further suggested that, apart from the question of pathogenesis,
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it is advisable not to neglect the dynamics of the child's feelings in the consideration of any skin complaint. Certain other common skin conditions are reviewed in their relation to the child's developing emotional state, in illustration of this contention.
The paper is based on general clinical data, and not on psycho-analytic findings.
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(1935). Childhood. Int. J. Psycho-Anal., 16:104-105