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Hives, which are also known as urticaria, are welts on the skin that often itch. Hives may also be referred to as urticarial wheals or nettle rash, since stinging nettles can be a common cause of this problem. Hives can also cause a certain amount of pain in some cases. Suffers report that they can also burn and sting.

What Do Hives Look Like?

Hives can appear anywhere on the skin and can vary in size to a millimeter to a few inches. Hives typically look like raised areas of the skin that have a red base. When there is a hives outbreak on the skin, the entire patch of skin that has been affected can be red. Hives that appear in clusters are known as welts. A common occurrence with hives is that when one spot or area subsides, other spots form on the skin (typically within 24 hours). This can give the appearance that hives are able to spread, however this is not the case. Hives are a localized condition and they are not contagious and are not able to spread from person to person. An acute hive appears suddenly and often disappears in a few days or weeks. Hives that last longer than six weeks are called chronic hives.

Common Causes of Hives

There are many possible causes of hives so it can be difficult to diagnose the root cause of the problem. However, often in Hives cases where there is a quick reaction or in cases where repeating an action is the cause, often the reason for the hives outbreak can be determined.

An allergic reaction to something is the typical cause of hives. However, it should be noted that this is not always the reason. In many cases of chronic hives the actual cause of the outbreak may be unknown.

Potential triggers for hives include: 

  • Allergic reaction to a medication
  • Certain viral infections can be an allergen
  • Sun exposure can be a trigger for hives. In addition, so can cold exposure, known as ‘cold urticaria’
  • Food allergy
  • Contact with animals such as dogs and cats (dander allergy)
  • Physical urticaria can be caused with contact to certain plants like stinging nettles
  • Insect bites and insect stings
  • Reaction to pollen from plants and trees
  • Illnesses such as lupus, which is a condition that affects the immune system
  • Stress, such as emotional stress is also known to be a trigger for hives in some individuals
  • Medications – hives can be caused by a reaction to a medication. Some very common medications such as penicillin, aspirin, and ibuprofen can be triggers.

Since in many cases hives are a side effect of a reaction to an allergen this means that individuals may also experience some other symptom or issue alongside of a hives outbreak. For example, hay fever or asthma suffers may be more susceptible to hives.

Medically, hives are caused when there is a release of inflammatory mediators, from the cutaneous mast cells, which causes blood vessels to leak fluid.

Diagnosis of Hives

Dr. Michele Green will need to obtain a complete medical history and will also carry out a physical exam during your consultation. Diagnosis of hives in many cases can be done by simply looking at the skin itself. In some situations a blood test may be required to rule out an illness or infection.

Allergy testing by an allergist may be needed to uncover the cause of the reaction. A common dermatology practice is to carry out a skin test or biopsy to help differentiate the rash from other similar reactions.

Another illness that is closely associated with hives and is often treated in a similar way is angioedema which is a form of swelling, often caused by an allergic reaction similar to hives. Both issues can occur simultaneously. Angioedema is a swelling of the upper skin, and often occurs around the eyes and lips. However, it can also present in other areas of the body too including the abdomen, arms and legs.

Hive outbreaks typically last for a few days and even when treated they will likely remain for at least 24 hours. If your hives continues longer than a few days it is worth seeking medical advice. Hives that last longer than six weeks are called chronic hives. If you have a very severe reaction, and the hives is spreading and you feel unwell or have difficulty breathing you should immediately speak to a doctor. Angioedema can also be serious so it is worth consulting a health professional for this issue.

Hives might also be associated with the very serious condition of anaphylaxis (which can be a life-threatening allergic reaction) since both hives and angioedema are symptoms of this condition.

Treatment Options for Hives

There are a number of different treatments available for hives, and typically the treatment should relate to the cause of the hives outbreak. When it comes to home remedies, a cold compress or lotion can relieve the itching and burning sensation on the skin. Hives can be heat sensitive so wearing cool clothing and avoiding exercising can help.

Common Treatments Include:

Prescription medications and over the counter drugs can be used as a chronic urticaria treatment option.

  • Oral corticosteroid drugs such as prednisone may be prescribed for the treatment of chronic hives. This is a medication that might cause side effects such as high blood pressure, so it is important to only take this under medical supervision.
  • Omalizumab (Xolair) is an injectable treatment that is used to help those who have suffered with hives for a long period of time, such as months and years.
  •  Antihistamines are perhaps the most common way to treat hives. Typical medications and brands that are used to treat hives include: Fexofenadine (known as: Allegra) Diphenhydramine (known as: Benadryl), Cetirizine (known as: Zyrtec),  loratadine (known as: Claritin) and Hydroxyzine (known as: Atarax). Some medications can make your drowsy, so you may wish too look for non-sedating treatments.
  •  Leukotriene-receptor antagonists are used to treat certain mast cell disorders, such as hives. Typically these are used when other treatments have not worked.

It is quite common for people to get the occasional outbreak of hives. However, if it is a re-occurring issue that repeatedly returns then medical assistance should be sort to try to determine what the trigger is for the hives outbreak. Without identifying the trigger the hives issues will likely continue.

If you’re concerned about certain skin conditions such as hives, please don’t hesitate to contact us online today or call 212-535-3088. Dr. Michele S. Green, a board certified NYC dermatologist, practices the latest techniques at the forefront of skin care.

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