What Is Hives On Skin

Treatment And Medication Options For Hives

How you treat hives depends on how many youve had and how long youve been suffering. If you have one hive that goes away within 24 hours and youre not having any breathing issues, you probably dont need medical attention. Instead, you might take a non-sedating, over-the-counter antihistamine like Claritin, Allegra, or Zyrtec to ward off a second one from occurring, Friedman says.

If you do get a second hive, taking one of these antihistamines should be your first defense. Its more about prevention or active treatment, Friedman says.

If a single hive lasts for longer than 24 hours or is more painful than itchy, or if hives continue to come and go for six weeks or more, its time to visit a dermatologist. You can always start with your general physician to get a referral, but because dermatologists are skilled at dealing with hives, theyre your best bet for recommending the appropriate treatment, Rossi says.

Swelling Can Be A Medical Emergency

Along with hives, some people develop swelling deep in their skin or the moist tissue that lines the mouth/lip, eyelids, or other areas. This swelling is called angioedema.

Angioedema is usually harmless however, it becomes a life-threatening emergency if it causes:

• Swelling in your mouth or throat

• Problems breathing

Angioedema can also cause noticeable swelling on the lips, eyes, and other parts of the body. It usually goes away in a few days. Until the swelling subsides, you may feel uncomfortable.

Swelling can be a medical emergency

If swelling develops in your mouth or throat or you have or difficulty breathing, get immediate medical care or go to the nearest emergency room.

Hives Are Very Common In Kids Too Heres How To Manage Them

Parents should know that given the high incidence of hives in kids, its likely theyll see hives on their child at least once. But dont panic. Acute urticaria is more common in the young , says Meghan Feely, MD, a board-certified dermatologist in private practice in New York City and New Jersey and a media expert for the American Academy of Dermatology.

Numerous triggers and allergens can cause hives in kids, but food in particular is a common one for kids, especially if theyre allergic to milk, eggs, peanuts, wheat, or soy. You may not even know theyre allergic to something until their first hive appears, especially if its accompanied by an allergic reaction called anaphylaxis, which requires emergency care.

Fortunately, most hives in kids can be treated at home with over-the-counter medication, and most hives in kids go away without much need to do anything. But if the hives continue, youll want to schedule an appointment with your pediatrician, who may request food allergy testing. Just make sure youre taking good notes about the hive incidents, which will help the doctor treat and manage the issue.

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Most People With Hives Do Not Need Tests

Tests are sometimes done when hives go on for long periods, or when unusual symptoms are occurring around the same time. This is to exclude other diseases, which may appear as hives first, and other conditions later. If hives are associated with high fever, bruising, bleeding into the skin, purple lumps that last for several days, or sore joints, a doctors appointment should be arranged promptly.

Allergy testing is performed when the history suggests an allergic cause.

What Are The Different Kinds Of Hives

Hives fall into two categories on the basis of the time they have been present:

• acute urticaria and
• chronic idiopathic urticaria .

Since hives are so common and acute urticaria, by definition, resolves spontaneously, physicians do not generally expend much time or expense to evaluate the cause of hives of less than eight weeks’ duration.

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How Are Hives Treated

The best treatment for hives is to find and remove the trigger, but this is not an easy task. Antihistamines are usually prescribed by your doctor to provide relief from symptoms. Antihistamines work best if taken on a regular schedule to prevent hives from forming in the first place.

Chronic hives may be treated with antihistamines or a combination of medications. When antihistamines don’t provide relief, oral steroids may be prescribed. A biologic drug, omalizumab , is also approved to treat chronic hives in people at least 12 years old.

For severe hives, you might need an injection of epinephrine or a cortisone medication.

What Can Urticaria Look Like

The inducible type of hives is triggered by a physical stimulus and can be either acute or chronic. Physical causes can result in repeated episodes of acute hives, or a persisting long-term condition.

Hives can be classed as follows:

• Acute – if it develops suddenly and lasts less than six weeks. Most cases last 24-48 hours. In some cases the rash only lasts a few hours. About 1 in 6 people will have at least one bout of hives in their lives. It can affect anyone at any age. Some people have recurring bouts of acute hives.
• Chronic – if it persists longer than six weeks. This is uncommon.

Hives can be triggered by a number of different physical causes. The reason why a rash appears in affected people is not clear. The physical stimulus somehow causes a release of histamine and other chemicals, which causes the rash.

The main types of inducible urticaria include the following:

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When To See The Doctor For Urticaria

Hives are not a serious condition that needs emergency treatment. If they come and go, watch out for any trigger to avoid future incidents. If they persist, and you suspect a case of chronic urticaria, then you should see your doctor. Also, if you notice red bumps on your skin that look like hives but leave a mark after they disappear, tell your doctor about it.

If your episode is accompanied by other signs like dizziness, stomach cramps, swelling, or trouble breathing, call your doctor immediately as this could be a sign of serious allergic reaction.

Is It Hives Or Something Else

Many skin disorders can cause irritated, itchy rashes, making it difficult to distinguish between chronic hives and other skin conditions.

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Itching, swelling, and red and white welts are all signs you may have hives or chronic idiopathic hives, if the welts appear consistently for six weeks or more and have no known cause. While any skin rash might seem to you to be an allergic reaction or hives, the reality is there are numerous skin disorders that can be mistaken for chronic hives.

How to Tell if Its Chronic Hives

If you notice a persistent, itchy skin rash, seeing a dermatologist is a good first step toward confirming a diagnosis and finding relief. Giving a complete medical history and undergoing a physical exam are the best ways to determine whats causing the rash or hives, and if there is a more serious skin disorder behind it, explains Joseph L. Jorizzo, MD, a professor of dermatology at Weill Cornell Medical College in New York City and Wake Forest Baptist Health University School of Medicine in Winston-Salem, North Carolina.

5 Skin Disorders Often Confused With Hives

Hives can be mistaken for other skin disorders, such as:

Pityriasis rosea. This common skin disease causes a splotchy red rash that appears on the body and typically lasts around six to eight weeks, although sometimes much longer. Unlike chronic hives, pityriasis rosea usually disappears on its own without treatment.

More Serious Skin Problems

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Pressure Or Delayed Pressure

This type of hives can occur right away, precisely after a pressure stimulus or as a deferred response to sustained pressure being enforced to the skin. In the deferred form, the hives only appear after about six hours from the initial application of pressure to the skin. Under normal circumstances, these hives are not the same as those witnessed with most urticariae. Instead, the protrusion in the affected areas is typically more spread out. The hives may last from eight hours to three days. The source of the pressure on the skin can happen from tight fitted clothing, belts, clothing with tough straps, walking, leaning against an object, standing, sitting on a hard surface, etc. The areas of the body most commonly affected are the hands, feet, trunk, abdomen, buttocks, legs and face. Although this appears to be very similar to dermatographism, the cardinal difference is that the swelled skin areas do not become visible quickly and tend to last much longer. This form of the skin disease is, however, rare.

When To Contact A Doctor

If hives happen alongside other symptoms, such as swelling and difficulty breathing, a person should seek emergency medical attention. They may be having a severe allergic reaction.

Severe itching can cause a person to scratch hard and break the skin. As a result, bacteria can enter the body and cause an infection.

People should also see a doctor if they notice any skin changes that may signal an infection, such as discoloration or the area feeling warm to the touch.

In about 5% percent of people who experience hives, it can be a sign of an underlying condition such as liver or thyroid disease.

Some risk factors for hives include having:

• asthma or a family history of asthma

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Infection Or Environmental Agent

Hives including chronic spontaneous hives can be a complication and symptom of a parasitic infection, such as blastocystosis and strongyloidiasis among others.

The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called urushiol-induced contact dermatitis. Urushiol is spread by contact but can be washed off with a strong grease- or oil-dissolving detergent and cool water and rubbing ointments.

Dermatographic urticaria is marked by the appearance of weals or welts on the skin as a result of scratching or firm stroking of the skin. Seen in 4â5% of the population, it is one of the most common types of urticaria, in which the skin becomes raised and inflamed when stroked, scratched, rubbed, and sometimes even slapped.

The skin reaction usually becomes evident soon after the scratching and disappears within 30 minutes. Dermatographism is the most common form of a subset of chronic hives, acknowledged as “physical hives”.

When To Call The Doctor

• The prescribed antihistamine medicine does not relieve the itching.
• The hives or itching becomes worse or new symptoms develop.
• Your child develops hives after being stung by an insect or after taking a new medicine or eating a certain food. He may need an EpiPen® to treat a more serious reaction next time.

HH-I-82 11/89, Revised 11/17, Nationwide Childrens Hospital

Next Steps

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Favorite Online Community For Support

This site brings together people with chronic idiopathic urticaria, which is a term that describes chronic hives with no explanation for whats causing them. The site has information about the condition, videos from people sharing their experience with hives, and The Hive, which allows people to send virtual support for people battling the condition.

Are Any Tests Needed

Usually no tests are needed. The rash is very typical and is easily recognised as hives by doctors. In many cases you will know what caused the rash from the events leading up to it. For example if you have just been put on a new medicine, or if your skin came into contact with a nettle, or if you were stung by a bee.

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Heat Or Cold Exposure

Heat and sweating or exposure to ice or very cold temperatures on the stomach can lead to hives. Maintaining the skin at a more constant, regular temperature can help whenever possible. Because babies cant regulate their body temperatures as well as adults, they may be especially vulnerable to temperature extremes.

Can Stress Cause Hives

Hives can also develop as a result of sun or cold exposure, infections, excessive perspiration, and emotional stress. The reason why stress seems to precipitate an outbreak of hives in many people is not completely understood but is likely related to the known effects of stress on the immune system. In many cases, the cause of hives in a given individual cannot be identified.

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What Are Hives And Angioedema What Do Hives Look Like

Hives appear on the skin as welts that are red, very itchy,smoothly elevated areas of skin often with a blanched center. They appear in varying shapes and sizes, from a few millimeters to several centimeters in diameter anywhere on the body.

• One hallmark of hives is their tendency to change size rapidly and to move around, disappearing in one place and reappearing in other places, often in a matter of hours.
• An individual hive usually lasts no longer than 24 hours. An outbreak that looks impressive, even alarming, first thing in the morning can be completely gone by noon, only to be back in full force later in the day.
• Very few skin diseases occur and then resolve so rapidly. Therefore, even if you have no evidence of hives to show the doctor when you get to the office for an examination, the diagnosis can be established based upon the accurate recounting of your symptoms and signs.
• Because hives fluctuate so much and so fast, it is helpful to bring along a photograph of what the outbreak looked like at its most severe point.

Who gets hives?

• It is estimated that 20% of all people will develop urticaria at some point in their lives. Hives are more common in women than in men.

Complications of hives

• Swelling deeper in the skin that may accompany hives is calledangioedema. This swelling of the hands and feet, as well as the face , can be as dramatic as it is brief.

How Can I Prevent Hives And Swelling

Allergy tests can help your healthcare provider figure out which substances bring on hives and swelling. Once you know your triggers, you can avoid them. You may want to:

• Cut certain foods or liquids out of your diet.
• Reduce exposure to airborne allergens.
• Switch to detergents and soaps without scents or dyes.
• Avoid extreme changes in temperature.
• Relax and take a break when youre stressed or overworked.
• Wear loose-fitting, lightweight clothing.

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How Is Urticaria Diagnosed

Urticaria is diagnosed in people with a history of weals that last less than 24 hours with or without angioedema. A medication and family history should be elicited. A thorough physical examination should be undertaken.

Skin prick tests and radioallergosorbent tests or CAP fluoroimmunoassay may be requested if a drug, latex, or food allergy is suspected in acute urticaria.

There are no routine diagnostic tests in chronic spontaneous urticaria apart from blood count and C-reactive protein , but investigations may be undertaken if an underlying disorder is suspected.

The autologous serum skin test is sometimes carried out in chronic spontaneous urticaria, but its value is uncertain. It is positive if an injection of the patient’s serum under the skin causes a red weal.

Inducible urticaria is often confirmed by inducing the reaction eg, scratching the skin in dermographism or applying an ice cube in suspected cold urticaria.

Investigations for a systemic condition or autoinflammatory disease should be undertaken in urticaria patients with fever, joint or bone pain, and malaise. Patients with angioedema without weals should be asked if they take ACE inhibitor drugs and tested for complement C4 C1-INH levels, function and antibodies and C1q.

Biopsy of urticaria can be non-specific. The pathology shows oedema in the dermis and dilated blood vessels, with a variable mixed inflammatory infiltrate. Vessel-wall damage indicates urticarial vasculitis.

Signs And Symptoms Of Hives

Hives, formally known in the medical community as urticaria, usually appears as red or skin-colored bumps or welts that have defined edges. They can be as small as a pen tip or as large as a dinner plate, and when you press the center of a hive thats red, it can turn white, something referred to as blanching. They can appear as one hive or show up as blotches or connected patches. And they show up to help control the bodys allergic response to certain triggers.

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What Are Hives Symptoms Causes Diagnosis Treatment And Prevention

If youve never experienced a bout of hives, consider yourself lucky. Roughly 20 percent of people do get hives at some point in their lives, making it a very common ailment. Hives can be a source of physical and mental anguish, especially if they appear frequently and continue happening for months or years.

What Is The Treatment For Urticaria

The main treatment of all forms of urticaria in adults and children is with an oral second-generation H1-antihistamine such as cetirizine or loratidine. If the standard dose is not effective, the dose can be increased up to fourfold . They are stopped when the acute urticaria has settled down. The addition of a second antihistamine is not thought to be helpful.

Terfenadine and astemizole should not be used, as they are cardiotoxic in combination with ketoconazole or erythromycin. They are no longer available in New Zealand.

Although systemic treatment is best avoided during pregnancy and breastfeeding, there have been no reports that second-generation antihistamines cause birth defects. If treatment is required, loratadine and cetirizine are currently preferred.

Conventional first-generation antihistamines such as promethazine or chlorpheniramine are no longer recommended for urticaria.

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