A 10-month-old girl presented with erythematous pruritic rash on cheeks, ears and trunk along with swelling of the feet for last 12 hours (Fig. 1a). She had a fever with coryza for two days and received three doses of paracetamol. Rashes were discrete, round, blanchable, and a few were ‘target lesions’ (Fig. 1b). There was no evidence of mucosal involvement, arthritis or involvement of any other system. Complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal. A diagnosis of urticaria multiforme was made and she was treated with hydroxyzine and ranitidine. The rashes gradually disappeared in next 4 days.

(a)	(b)
Fig.1 Erythematous rash on cheeks, ears and trunk.

Urticaria multiforme, a form of acute annular urticaria, is a benign, self-limiting cutaneous hyper-sensitivity reaction mediated by histamine. It is characterized by the acute and transient onset of blanchable, arcuate, annular, polycyclic, erythematous wheals and facial or acral edema. It usually occurs in children between 4 months and 4 years. Viral illness, immunization and drugs like antibiotics or paracetamol could be the inciting factors. Erythema multiforme, urticarial vasculitis (both having fixed lesions, dusky, purpuric centers often with necrosis and blistering which resolve slowly over weeks with post inflammatory depigmentation; and mucosal erosions); and serum sickness (high grade fever, myalgia, arthralgia, lymphadenopathy and frequent neutropenia in addition to skin and mucosal involvement) are important differential diagnoses.