Overview
Chronic hives, also known as urticaria, are skin reactions that cause itchy welts. These welts last for more than six weeks and often recur over months or years, with the cause not being clear in many cases. The welts can vary in size, change shape, appear and fade repeatedly, and cause intense itchiness. In addition to itchiness, chronic hives can also include painful swelling around the eyes, cheeks, or lips. Triggers for chronic hives can include heat or cold, sunlight, vibration, pressure on the skin, and medical conditions such as thyroid disease, infection, allergy, and cancer. While chronic hives do not put you at sudden risk of a serious allergic reaction, if hives occur as part of a severe allergic reaction, seek emergency care. If you have severe hives or hives that last for more than a few days, it's recommended to see your healthcare provider.
Understanding the disease
Symptoms
Symptoms of chronic hives include:
- Batches of welts (wheals) that can arise anywhere on the body
- Welts that might be red, purple or skin-colored, depending on your skin color
- Welts that vary in size, change shape, and appear and fade repeatedly
- Itchiness (pruritus), which can be intense
- Painful swelling (angioedema) around the eyes, cheeks or lips These symptoms persist for more than six weeks and recur frequently, sometimes for months or years.
Risk Factors
Chronic hives, also known as urticaria, are welts that last for more than six weeks and return often over months or years. The cause of chronic hives is often unclear, but they can be triggered by a variety of factors, including:
- Heat or cold
- Sunlight
- Vibration, such as caused by jogging or using lawnmowers
- Pressure on the skin, as from a tight waistband
- Medical conditions, such as thyroid disease, infection, allergy, and cancer It is important to identify and avoid known triggers to help manage chronic hives.
Development
Chronic hives develop when the immune system releases chemicals, such as histamine, into the bloodstream, causing skin reactions. The exact cause of chronic hives is often unknown, but they can be triggered by various factors, including heat, cold, sunlight, vibration, pressure on the skin, and certain medical conditions like thyroid disease, infection, allergy, and cancer. These welts vary in size, change shape, appear and fade repeatedly, and can be itchy and painful, especially around the eyes, cheeks, or lips. If you have chronic hives that persist for more than six weeks and recur often, you should consult a healthcare provider for proper evaluation and management.
Assessment and Diagnosis
Diagnosis
To diagnose chronic hives, your health care provider will likely ask about your symptoms and examine your skin. They may also ask you to keep a diary to track: your activities, any medications or supplements you take, what you eat and drink, where hives appear, and how long it takes for a welt to fade. Blood tests may be necessary to determine the cause of your symptoms. In some cases, a skin sample (biopsy) may be taken to examine under a microscope to clarify the diagnosis.
Management and Treatment
Complications
Chronic hives do not put you at sudden risk of a serious allergic reaction (anaphylaxis) but can lead to complications such as painful swelling (angioedema) around the eyes, cheeks, or lips. Other potential complications include itchiness (pruritus), which can be intense, and flares triggered by heat, exercise, or stress. If you have severe hives or hives that last for more than a few days, it's recommended to see your healthcare provider. If you experience symptoms of anaphylaxis, such as dizziness, trouble breathing, and swelling of the tongue, lips, mouth, or throat, seek emergency medical care.
Prevention
Chronic hives can sometimes be prevented by avoiding known triggers and taking general preventive measures. While the exact cause of chronic hives is often not known, avoiding triggers can help reduce the likelihood of outbreaks. Common triggers include heat, cold, sunlight, vibration, pressure on the skin, and certain medical conditions such as thyroid disease, infection, allergy, and cancer. Taking anti-itch medications (antihistamines) can also provide relief and help prevent scratching, which can further aggravate the skin. It's essential to consult a healthcare provider if you have severe hives or hives that last for more than a few days.
Home Remedies
Home remedies for chronic hives may include the following:
- Cool compresses: Applying a cool, damp cloth to the affected area can help alleviate itching and reduce swelling.
- Oatmeal bath: Colloidal oatmeal, found in products like Aveeno, can help soothe the skin and reduce itchiness.
- Aloe vera: Applying aloe vera gel to the affected area can provide relief from itching and inflammation.
- Antihistamines: Over-the-counter antihistamines like cetirizine (Zyrtec), loratadine (Claritin), or diphenhydramine (Benadryl) can help reduce itching and swelling.
- Calamine lotion: Calamine lotion can help soothe itchy skin and provide relief from hives.
- Cold showers or baths: Exposure to cool water can help reduce itching and swelling.
- Avoiding triggers: Identifying and avoiding known triggers, such as heat, certain foods, or chemicals, can help prevent hives from occurring.
- Relaxation techniques: Managing stress through techniques like deep breathing, meditation, or yoga can help reduce the frequency of hives flare-ups.
- Avoiding tight-fitting clothing: Wearing loose-fitting, breathable clothing can help reduce irritation and itchiness.
- Avoiding harsh skincare products: Using gentle, fragrance-free skincare products can help prevent further irritation. While these home remedies may provide some relief, it's essential to consult a healthcare provider if the chronic hives persist or worsen, as they can provide guidance on proper treatment and management.
Treatment
Chronic hives can be treated with a combination of prescription and non-prescription medications, as well as lifestyle and home remedies. The first line of treatment for chronic hives usually involves non-prescription anti-itch drugs (antihistamines) like loratadine and cetirizine. If these don't work, prescription antihistamines can be prescribed. In some cases, other medications may be recommended, such as famotidine, montelukast, doxepin, cimetidine, nizatidine, ranitidine, or omalizumab. For more severe cases that don't respond to these treatments, immunosuppressive drugs like cyclosporine, tacrolimus, hydroxychloroquine, or mycophenolate may be prescribed. Managing chronic hives also involves avoiding triggers, such as foods, medications, pollen, pet dander, latex, and insect stings. Applying cold, taking comfortably cool showers or baths, using anti-itch creams or lotions, wearing loose cotton clothing, protecting your skin from the sun, and tracking your symptoms can help alleviate discomfort and potentially identify triggers. It's important to consult with a health care provider before starting any new medications, particularly if you're pregnant, breastfeeding, have a long-term medical condition, or take other medications.
Preparing for medical consultation
To prepare for an appointment for chronic hives, you should:
- List your symptoms, including when they occurred and how long they lasted.
- List any medications you're taking, including vitamins, herbs, and supplements, along with doses and directions.
- Create a list of questions to ask your doctor.
- Keep track of your activities, diet, and any factors that worsen or improve your symptoms.
- Be prepared to discuss the appearance of your skin reaction when it first appeared, any changes in your symptoms, and any triggers you've noticed.
- Be open about any concerns you have regarding your treatment options and potential side effects. Remember to consult with your healthcare provider before taking any medications if you are pregnant, breastfeeding, have a long-term medical condition, or are on other medications.