Chronic hives, which may also be known as chronic urticaria, are similar to the hives most people are familiar with seeing appear as an allergic reaction or due to a viral infection. However, there are a few main differences between regular hives (called acute hives) and chronic hives. Let’s dive deeper into the symptoms, causes, and treatment of chronic hives, as well as how to find relief.
Chronic Hives Symptoms
Hives appear when the immune system releases chemicals such as histamine into the bloodstream, creating welts. Although it is often in response to some type of trigger, the irritant is not always apparent.
Chronic hives consist of three main hives symptoms: red welts, swelling, and itching. Hives can often be mistaken for a rash, especially if symptoms persist and become chronic, but these symptoms will help you to identify whether the condition is hives.
1. Welts
Welts are most often red, but they can also be purple or flesh-colored. They will be raised slightly from the skin. If the hives are red, whether they are chronic or not, the center of the welt will turn white when pressed. Welts usually appear suddenly and are sometimes solitary, but they also frequently form in patches. As hives come and go daily, you may notice they change in shape and size. Welts can appear anywhere on the body, but often appear in the same area if the reaction is due to a specific trigger, like an infection or allergy. These types of welts are called fixed hives (urticarial vasculitis).
2. Swelling
Swelling, also known as angioedema, occurs when the welts have formed under the skin. This often occurs in addition to typical, surface-level welts. When swollen, you may notice heat radiating from the area. While the eyes and lips are most commonly affected by angioedema, the feet, throat, and hands can also be affected.
3. Itching
Itching, especially with chronic hives, is one of the most bothersome hives symptoms. Itchiness may range from minor irritation to severe pain. While you may be tempted to scratch your chronic hives, excessive itching can lead to skin tears and possibly infection, so it’s best to avoid itching as much as possible.
Chronic Hives Causes
Unfortunately, the cause of chronic hives is often unknown. However, many times the causes of hives, whether acute or chronic, are the same. This includes, but is not limited to the following:
- Allergic reactions
- Autoimmune conditions
- Other medical conditions, like asthma, liver disease, or cancer
- Pain medications
- Heat or cold (particularly when there are rapid changes to body temperature)
- Stress
- Insects or parasites
- Infection (bacterial or viral)
- Scratching
- Sunlight or other weather factors
- Exercise
- Friction or pressure on the skin, such from tight clothing
Autoimmune conditions may be a trigger of chronic hives, with about 1 in 5 people who develop chronic hives also having an autoimmune condition like diabetes, thyroid disease, celiac disease, or vitiligo.
Some forms of cancer may cause chronic hives, including thyroid cancer, breast cancer, lymphoma, and others.
However, it is important to note that simply developing chronic hives does not necessarily indicate you have an underlying condition; hives can be triggered by almost anything bothering your body, including both external and internal irritants. This is why causes of chronic hives are so difficult to pinpoint; the good news is there are still options available to help treat your chronic hives, even if the cause is not immediately apparent.
How Long Do Chronic Hives Last?
In many cases, hives disappear as suddenly as they appear. While most hives often disappear within 24 hours and are almost completely gone within a few weeks, chronic hives last for over six weeks. They also occur frequently over months and years.
Chronic Hives Treatment
While a case of chronic hives does not put you at any more risk for a severe allergic reaction, a dermatologist can help alleviate chronic urticaria symptoms. A dermatologist can run tests such as blood work, a skin biopsy, or allergy tests to try and identify the cause of your hives. This information will help identify the best hives treatment options for you.
Before your appointment, begin to track your flare ups. This can help you and your dermatologist pinpoint potential triggers that may be causing your chronic hives to appear. It’s also important to document your hives with pictures as your hives may change shape or disappear before your appointment.
While antihistamines are prescribed for acute hives, medications that alleviate redness and swelling may also prescribed for chronic hives. These medications include dapsone, corticosteroids, immunosuppressants, or omalizumab. An injection of epinephrine can also help alleviate swelling.
It’s important to remember that even without a known cause of your chronic hives, you can have effective treatment. Be honest with your dermatologist about how your body is reacting to the medication. Your dose may need to be adjusted or another medication may need to be used if you are not seeing the expected results.
How Do You Live with Chronic Hives?
While living with chronic hives may feel daunting, there are ways to help alleviate symptoms and prevent them from taking over your life.
- Keep your skin hydrated. Hydrated skin is less prone to itchiness. Consistently apply lotion to your skin after a shower or washing your hands. Taking cool showers or baths will also help keep your skin hydrated, as hot showers quickly dry out your skin. An oatmeal bath can both hydrate your skin and alleviate itchiness.
- Discuss vitamin supplements with your dermatologist. Studies have found that taking a Vitamin D supplement can decrease hives symptoms. Discuss vitamin supplements with your dermatologist to determine if this may be an appropriate treatment for your chronic urticaria.
- Dress appropriately for the weather and your triggers. Extreme weather can be a trigger for your hives. So, dressing appropriately, whether it’s to keep your skin protected from sun exposure or harsh winds, can help prevent a flare-up. You may also notice that dressing in fabrics like cotton or silk helps prevent hives flare-ups as well, since these fabrics allow your skin to breathe and are less irritating to your skin.
You do not have to suffer while waiting for chronic hives to disappear. Seeking care from your dermatologist can help alleviate your symptoms. Vujevich Dermatology Associates offers medical, surgical, and cosmetic dermatology from some of the most highly trained physicians and clinicians in the greater Pittsburgh area. You can reach our team at 412-429-2570 or visit our contact page to see all of our locations. You can also follow us on Facebook to see what’s new in the world of dermatology.