M A Skin Clinic

Urticaria / Hives

Urticaria, also known as hives, is a skin disease that occurs due to an infection or allergy due to a certain medication, food etc. The rashes or red patches caused due to urticaria are short lived and go away with time.

Hives are raised bumps on the skin that often itch. These bumps can appear on any part of the skin. Hives vary in size from as small as a pen tip to as large as a dinner plate. They may connect to form even larger wheals.
A hive often goes away in 24 hours or less. New Hives may appear as old ones fade, so Hives may last for a few days or longer. A bout of Hives usually lasts less than 6 weeks. These Hives are called acute Hives. If Hives last more than six weeks, they are called chronic Hives and this type should be thoroughly investigated through blood tests, skin biopsy and immunofluorescence technique. Many patients prefer not to get investigated, this is dangerous. Quoting Dr Agarwala, “It is like someone has repeated fever for weeks and months but instead of finding the cause they and their family prefer taking paracetamol. This is against the medical wisdom.”We should make an attempt to find the underlying cause.
Hives can cause the eyelids and lips to swell.If you have any trouble breathing or swallowing, get emergency care right away by visiting a nearby hospital.

  • Slightly raised, pink or red swellings.
  • Wheals that occur alone or in a group, or connect over a large area.
  • Skin swelling that subsides or goes away within 24 hours at one spot but may appear at another spot.
  • Sometimes they itch, sting or leave a mark on skin.

Hives are common. Anyone can get them.

An allergic reaction can trigger Hives. Things that commonly trigger an allergic reaction include:

  • Foods: Fruits (especially citrus fruits), milk, eggs, peanuts, brinjals, fish and milk.
  • Medicines.
  • Insect bites and stings.
  • Animals.
  • Pollen.
  • Touching something to which you are allergic, such as latex.
  • Vaccination.

Other causes of Hives are:

  • Infections.
  • Some illnesses, including a type of vasculitis, lupus, and thyroid disease.
  • Exposure to sun (Solar Urticaria), heat, cold, or water.
  • Exercise.
  • Stress.
  • Pressure on the skin, such as from sitting too long.
  • Contact with chemicals.
  • Scratching the skin.

When a patient has Hives, a dermatologist can often make the diagnosis by looking at the skin. Finding the cause of Hives, however, can be a challenge. This is especially true for Hives that have been around for more than six weeks.
To find out what is causing your Hives, a dermatologist will review your health history, ask questions, and do a physical exam. You may also need the following tests:

  • Allergy tests (on the skin or blood tests).
  • Blood work (to rule out an illness or infection).
  • A skin biopsy and DIF.
  • Antihistamines.
  • Corticosteroids like prednisone. These are prescribed for short-term use due to side effects with long-term use.
  • Dapsone. This is an antibiotic that can also relieve redness and swelling.
  • Omalizumab. This medicine can help patients with Chronic Idiopathic Urticaria (CIU)that can last for months or even years. It is an advanced method of treatment. Check if it is available with your dermatologist.
  • There are other medications as well which can be used on case to case basis as prescribed by your dermatologist.

For most people, Hives are not serious. Children may outgrow the allergies that cause their Hives. The quality of life is significantly affected and hence appropriate treatment is much needed. If the Hives remain or become severe, it is important to get medical care. Hives can be a sign of an internal disease.

  1. Take photos of your Hives. When you see your dermatologist, you may not have Hives. Taking pictures can help your dermatologist make sure you have Hives. Other skin conditions can look like Hives.
  2. Relieve the itch at home. Itch is common in people who have chronic Hives. Here are some ways to get temporary relief:
    • Avoid overheating.
    • Wear loose-fitting, cotton clothes.
    • Apply a cold compress, such as ice cubes wrapped in a washcloth, to the itchy skin several times a day—unless cold triggers your Hives.
    • Use anti-itch medication that you can buy without a prescription, such as an antihistamine or calamine lotion.
    • Prevent dry skin by using a fragrance-free moisturizer several times a day.
  3. Stay calm. Stress can trigger Hives. If you feel stressed often, healthy ways to reduce your stress include, exercising every day, meditating, and practicing mindfulness.
  4. Know that treatment can be effective when the cause(s) of your Hives remains unknown. It’s helpful to find out what’s causing your Hives, but sometimes, a cause cannot be found. About 50% of people who have chronic Hives never find out what’s causing their flare-ups. Even when you cannot find the cause, treatment can help you clear your skin and prevent new flare-ups.
  5. Follow your treatment plan. For treatment to be effective, it’s essential to follow the treatment plan your doctor creates for you.Treatment may fail to work when you take medication less often than prescribed. For example, if your dermatologist prescribes a daily antihistamine and you only take it when you have a flare-up, you may continue to get Hives.
  6. Tell your dermatologist if treatment fails to work. If you are following your treatment plan exactly as instructed, you may still have flare-ups. Hives can be stubborn, but treatment can still work.
    To give you relief, your dermatologist may:
    • Increase the dose of a medication.
    • Add another medication to your treatment plan.
    • Prescribe a different medication.
    Before changing your treatment plan, be sure you’ve followed the original treatment plan.
  7. Understand that extensive allergy testing rarely helps. Many people believe that their Hives would go away if they could just find out what’s causing the flare-ups but many a times it is not just one thing. Even when the cause remains unknown, treatment can clear your skin and keep it clear.Allergy testing seldom helps.
Urticaria Hives

Urticaria Hives