Hives and Your Skin

Overview Urticaria / Welts/ Hive Rash on skin Hives is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear unexpectedly, either as a result of the body’s reaction to certain allergens or for unknown causes.  Hives generally cause itching, burn, or sting. They can appear anywhere on the body, […]


Urticaria / Welts/ Hive Rash on skin

Hives is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear unexpectedly, either as a result of the body’s reaction to certain allergens or for unknown causes.
 Hives generally cause itching, burn, or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives differ in size (from a pencil eraser to a dinner plate), and may join together to form larger areas called plaques. They can last for hours, or up to one day before disappearing.
 Angioedema is similar to hives, but the swelling happens underneath the skin instead of on the surface. Angioedema includes characters such as; deep swelling around the eyes and lips and occasionally of the genitals, hands, and feet. It usually lasts longer than hives, but the swelling generally goes away in less than 24 hours.  Angioedema of the throat, tongue, or lungs would rarely interrupt the airways, causing difficulty breathing. This may become life-threatening.

Angioedema & Hives causes

These may form in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin’s blood vessels.

Allergic reactions, chemicals in certain foods, insect stings, sunlight exposure, or medications can all cause histamine release. It’s usually impossible to figure out exactly why hives have formed.

There are several different types of hives, including:

Acute urticaria: These are hives lasting less than six weeks. The most common reasons are certain foods, medications, or infections. Insect bites and internal disease may also be accountable.

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk. Fresh food results hive more frequently than cooked foods. Certain food additives and preservatives may also be to blame.

Drugs like aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen, high blood pressure drugs (ACE inhibitors), or painkillers such as codeine, can cause hives and angioedema

Chronic urticaria and angioedema: Hives lasting more than six weeks. The cause of this type of hives is often more difficult to recognize than those causing acute urticaria. It is impossible to determine the cause for most people with chronic urticaria. In some cases, the reason may be thyroid disease, hepatitis, infection, or cancer.

Chronic urticaria and angioedema can influence other internal organs such as the lung muscles, and gastrointestinal tract, which includes symptoms such as, shortness of breath, muscle soreness, nausea, and diarrhea.

Physical urticaria: Hives caused by direct physical stimulation of the skin ( for example; cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives often occur right where the skin was stimulated and seldom appear elsewhere. Most of the hives appear within one hour after exposure.

Dermatographism: This is a common form of physical urticaria where hives form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.

Cholinergic / Heat urticaria

Cholinergic urticaria (CU) is a type of hives caused by raised body temperature. It normally develops when you exercise or sweat. CU appears and disappears on its own within a few hours. In serious cases, CU can sometimes be related to exercise-induced anaphylaxis.

Cold urticaria

This is a skin reaction to cold that shows up within minutes after cold exposure. The affected skin develops reddish, itchy welts. People with cold urticaria experience widely different symptoms. Some have mild reactions to the cold, while others have severe reactions.

Stress hives

Stress can trigger an outbreak of hives that can make up a stress rash/welts.

Aquagenic urticaria

Aquagenic urticaria is a rare condition in which urticaria hives forms rapidly after the skin comes in contact with water, regardless of its temperature. It usually affects women and symptoms often start around the onset of puberty. Some patients report itching too. It is a form of physical urticaria.

Dermatographic urticaria

This is a common, tender skin condition. People who have this condition develop welts or a localized hive-like reaction when they itch their skin. It can also happen when the skin is exposed to pressure or rubbing. This condition is also called skin writing, dermographia, or dermatographic urticaria

Papular urticaria

Papular urticaria is an increased sensitivity (almost like an allergic reaction) to bug bites. The most common types of bugs that cause papular urticaria include fleas, bed bugs, biting midges, and mosquitoes.

Chronic idiopathic urticaria

Chronic idiopathic urticaria (CIU) is a form of chronic hives that results in itchy, red bumps, or wheals on your skin. People with CIU usually have flares that come and go for several years, but doctors haven’t identified a direct cause

Solar urticaria

SU is a rare condition in which exposure to ultraviolet or UV radiation, or sometimes even visible light, induces a case of hives that can appear in both covered and uncovered areas of the skin. It is classified as a type of physical urticaria.

Hives in children

Hives are very common in kids, as they are in adults. Hives tend to look the same on children as they do on adults.

Occasionally, hives in some kids require emergency care. A food allergy can trigger a severe allergic reaction called anaphylaxis, which can be deadly. Symptoms include difficulty breathing, dizziness and fainting, nausea and vomiting, abdominal pain, diarrhea, rapid heartbeat, throat tightness, and hoarse voice.

How Are Hives and Angioedema Diagnosed?

Your doctor will question you in an endeavor to find the possible reason for hives or angioedema. Since there are no specific tests for hives or the associated swelling of angioedema, testing will rely on your medical history and a thorough exam by your primary care doctor or dermatologist.

Skin tests may be carried out to determine which substance you are allergic to. Routine blood tests are done to determine if a system-wide illness prevails.

Hives symptoms

  • The appearance of wheals as a rash on the skin
  • Itchiness
  • Swelling

Angioedema and Hives/ Urticaria Treatment

Recognizing and removing the trigger is the best treatment for hives and angioedema, which is not an easy task. Antihistamines are generally prescribed by your doctor to provide relief from symptoms. Antihistamines work best if taken on a regular schedule to avoid hives from forming in the first place.

Chronic hives may be treated with antihistamines or a combination of other medications. When antihistamines don’t provide relief, oral corticosteroids may be recommended. A biologic drug, omalizumab (Xolair), is also accepted to treat chronic hives in those at least 12 years of age.

For serious hives or angioedema, an injection of epinephrine (adrenaline) or a cortisone medication may be needed.

Home remedies for hives

  • Oatmeal bath
  • Aloe Vera
  • Cold compress
  • Calamine lotion
  • Supplements such as fish oil.

How Can Hives Be Managed?

While you await the hives and swelling to fade, here are few things which you can do:

  • Apply cool compresses or wet cloths to the infected areas.
  • Try to work and sleep in a cool room.
  • Wear loose-fitting lightweight clothes.

When Should I Call the Doctor About Hives?

Contact your doctor immediately if hives or angioedema occur with any of the following symptoms:

  • Dizziness
  • Wheezing
  • Difficulty breathing
  • Tightness in the chest
  • Swelling of the tongue, lips, or face

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