What are Hives (Urticaria)?
These lectures are not meant to replace your physician and are simply provided as a free educational service to all our visitors. If you feel that you have a skin problem, please see your doctor.
Urticaria is a common skin disorder that is characterized by the spontaneous development of swollen pink or red itching areas called "hives", "whelps", or "wheels". These are produced by the leakage of a liquid portion of the blood through the walls of tiny blood vessels into the skin or mucous membranes of the body.
Urticaria usually comes on abruptly, with large numbers of "hives" in repetitive crops. A "hive" can be a few inches to several inches in size and when individual "hives" join together they can even cover an entire body area. An individual "hive", from a particular crop, will usually disappear after a few minutes to several hours without leaving any permanent changes in the skin. Typically, most individuals, have a single attack of urticaria that lasts only briefly - for several days. This is referred to as ACUTE URTICARIA. Unfortunately, some cases of urticaria may also persist and "come and go" with attacks being intermittent or continual for years. When urticaria lasts more than three months, we refer to that type as CHRONIC URTICARIA.
DERMOGRAPHISM AND PRESSURE URTICARIA
Dermographism is a special form of hives in which a raised, red swelling appears in an area of skin after it is stroked with a dull, pointed object. Pressure urticaria is somewhat similar to dermographism in that the hives are produced in response to a physical agent pressing on the skin. Here the reaction can be seen under tight clothing areas or on soles of the feet after standing.
Angioedema is another variant of hives in which large areas of skin, such as the upper lip, face, arms, or legs, may be swollen. A special form of angioedema of a hereditary type is called "QUINCKE'S EDEMA". In this condition, there is an abnormality in a component of the blood called COMPLEMENT.
Cholinergic urticaria is a special, and not uncommon form of urticaria that can be due to emotional stress - as well as heat stress and exercise. This is due to how the individual reacts to the release of a normal body chemical from nerve endings called (ACETYLCHOLINE). This produces, in the susceptible individual, a characteristic type of small flea bite sized hives, which only last for a few minutes.
Hives develop because of an allergic response or reaction to food, medication, inhalant, infectious agent, physical agent or internal disease. Although the theory is not accepted by all, it is possible that some cases of urticaria may even be due to an emotional cause. The reason for your hives may remain obscure despite lengthy investigation. Laboratory studies will be needed to exclude internal diseases which may also cause urticaria.
Removing the material which causes the allergic reaction is the cornerstone of successful treatment. Otherwise, we can only treat symptoms and the condition will persist. A careful history of the patient's dietary and medication habits will sometimes uncover the cause of urticaria. When this fails, and urticaria is felt to be due to a food or medication allergy, it is necessary for patients to keep a detailed minute by minute record of all foods and medications along with comments regarding the status of the condition in an attempt to determine the cause.
When neither laboratory data, history or the diary of materials taken as medications or as food has not been helpful in finding the cause of chronic urticaria, evaluation by an Allergist is necessary.
Patients with urticaria should be especially careful in taking any new drugs of any type (EITHER PRESCRIBED OR OVER THE COUNTER) - as it might contain the same or a similar chemical to what is causing the urticaria in the first place! Any suspected old drugs should be eliminated for several months. It may even be necessary to discontinue all medications.
MEDICATIONS IN THE TREATMENT OF URTICARIA
Some measure of immediate relief may be obtained by cool baths and the application of a soothing lotion.
Antihistamines are often helpful. In some patients, several of these may need to be tried in succession, or two of these may need to be used simultaneously before the best effect is obtained. Although corticosteroids may, on occasion be used in severe, acute attacks, they are not advisable for most instances of chronic urticaria.
Anytime severe itching persists, use a product that is formulated in a soothing, emollient base, such as Sarna Lotion - an excellent anti-itch lotion that will provide immdediate relief of itchy skin. Sarna contains 0.5% each of camphor and menthol to provide the immediate sensation of a cool anti itch lotion. In those conditions that are characterized by chronic and recurrent itchy skin, Sarna Lotion provides the relief to calm the irritating and antagonizing symptom of itch.
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