Chronic urticaria is a condition in which an itchy rash intermittently persists for six weeks or longer. The cause of the rash is often not clear. Many people also develop swelling of the lips, tongue or other areas of the body from time to time. Symptoms can often be relieved with antihistamine pills.
On this page
- What is chronic urticaria?
- What does the rash of urticaria look like?
- Are there any other symptoms?
- What causes chronic hives?
- Is severe chronic urticaria?
- What is the course and outcome (prognosis) for chronic urticaria?
- What are the treatments for chronic urticaria?
What is chronic urticaria?
Urticaria (sometimes called hives) is an itchy rash caused by small amounts of fluid that leaks from blood vessels just below the skin surface. Urticaria is classified as:
- Acute urticaria – if it develops suddenly and lasts less than six weeks. Most cases the last 24-48 hours. Approximately 1 in 6 people will have at least one episode of hives in their lifetime. It can affect anyone at any age. Some people have recurrent episodes of acute urticaria.
- Chronic urticaria – if it persists over time. Chronic means persistent or permanent. In chronic urticaria rash develops on most days for at least six weeks. This is rare. About 1 in 1,000 people develop chronic urticaria at some point in their lives. It is twice as common in women as in men. Some people have a rash on and off for months, or even years.
The rest of this leaflet deals only with chronic urticaria.
What does the rash of urticaria look like?
The rash can affect any area of skin. Small raised areas called wheals develop on the skin. The rash looks mild and itchy blisters. Each white or red weal and is usually surrounded by a small red area of the skin is called an outbreak. The hives are commonly 1-2 cm wide, but can vary in size. There may be a few, but sometimes develop in many different parts of the body. Sometimes bumps that are next to each other are joined to form larger ones. The hives can be any shape but are often circular.
Weal fades as the surrounding flare is maintained for a time. This causes the affected area of the skin and look spotted red. The spots gradually fade and then the skin returns to normal. Each papule usually lasts less than 24 hours. However, as some fade, others may appear. Then, it may seem as if the eruption is moving around the body. The rash can completely erase only to return a few hours or days later.
Are there any other symptoms?
- The appearance of the rash and itching can cause distress.
- A related condition called angioedema occasionally occurs in about half of people with chronic urticaria. In this condition too little liquid seeps into the deeper tissues under the skin, causing the tissue to swell.
- The swelling of angioedema can occur anywhere in the body but most commonly affects the eyelids, lips and genitals.
- Sometimes, tongue and throat are affected and swollen. The swelling sometimes becomes strong enough to cause difficulty breathing.
- Angioedema symptoms tend to last longer than urticaria hives. It can take up to three days for inflamed areas to diminish and disappear.
- A variation called urticarial vasculitis occurs in a small number of cases. In this condition, the rash lasts more than 24 hours, often painful, can become dark red, and may leave a mark on the skin pigmented red when good will.
What causes chronic hives?
A trigger is believed to cause the release of chemicals (such as histamine) of the skin cells. Chemicals that the fluid leaking from tiny blood vessels in the skin surface. The pools of liquid to form hives. The chemicals can also cause blood vessels to open (dilate), which causes the flare around the weals. The trigger is not known or identified in many cases. Possible causes in some cases are:
- In up to a third of cases, the cause may be an autoimmune problem. Means that the antibodies autoimmune disease causing organism. Antibodies normally fight germs (viruses and bacteria). In some people, a type of antibody binds to the cells under the skin and causes the release of histamine and other chemicals. The reason why this happens is unclear.
- An allergy to a food, drug or parasites (like worms in the intestine) is a rare cause of chronic urticaria. A skin specialist may advise testing if you suspect an allergy.
- Physical urticaria. This is when a localized rash occurs when skin is physically stimulated. The most common is called dermographism when a rash on areas of the skin that is firmly stroked. Sometimes a rash with urticaria is caused by heat, cold, emotion, exercise or intense sunlight. See separate leaflet called 'Physical Hives'. This type of urticaria attacks often cause acute symptoms, but sometimes cause persistent chronic symptoms.
- A bacterium (germ) called Helicobacter pylori which is commonly found in the stomach can be a factor in some cases. If you are infected with this bacteria and clears without treatment, can cure the problem with hives.
Is severe chronic urticaria?
The rash is usually itchy. Each papule usually lasts less than 24 hours. However, as the eruption constantly appear and disappear, itching may cause distress and difficulty sleeping. The attacks of angioedema that occur from time to time in half of people with chronic urticaria can sometimes cause severe breathing problems.
What is the course and outcome (prognosis) for chronic urticaria?
Chronic urticaria tends to come and go. You may have times when the rash appears on most days, and then times when the rash may disappear for a while. The severity of the rash and pruritus varies from person to person. Some things such as heat, cold, menstrual periods, stress and emotions can cause rash until the rash worse than usual.
- The symptoms may go away completely after a few months, but the state has a duration of several years in some cases.
- In about half of cases, symptoms go within 3-5 years after it first started.
- In about 1 in 5 cases, symptoms persist intermittently for over 10 years.
What are the treatments for chronic urticaria?
Histamine release under the skin is involved in the cause of urticaria. Antihistamines block the action of histamine. Most affected are at least partial relief, and sometimes total relief of their symptoms with antihistamines. Several antihistamines:
- Among the elderly tend to cause drowsiness, but can be helpful to take before bedtime.
- Modern antihistamines are less likely to cause drowsiness. If necessary, you can take them regularly.
- Some people take longer than a sedating antihistamine at bedtime, and a modern non-sedating during the day.
- Some people respond to an antihistamine better than another. If an antihistamine has not helped much, one can better meet different. Usually worth trying an antihistamine for 1-2 weeks before deciding whether it is helping or not.
- Some people take antihistamines "as needed" when symptoms flare up. However, if the rash usually develops on three or more days a week, it's best to take an antihistamine every day if the rash is present or not. This is to prevent the rash and itching of development instead of taking medication from time to time, in response to a rash that develops.
Easing the rash
Creams such as menthol in aqueous cream are useful to cool the skin and help relieve the itching. A warm bath or shower can relieve itching and before bed helps you sleep.
Avoiding triggers or aggravating factors
Occasionally a trigger such as a foodstuff is identified that causes rash. Can then be able to avoid. However, it is rare to identify an activator. For example, if a trigger food is suspect, then you may be asked to keep a food diary to try to identify what food is responsible.
Several other factors may worsen symptoms (but not the main trigger). The following are things that some people have found helpful, but there is little evidence that they work around the world:
- Try to avoid tight clothing such as hives sometimes tend to occur at sites of local pressure. For example, belts, shoes under adjusted, etc.
- Try to keep cool as urticaria may tend to worsen in warmer conditions. In particular, keep the room cool at night.
- Some things worth considering include: alcohol, hot baths, strong sunlight, and undue emotion. If you think any of these symptoms are getting worse it can be useful to avoid them.
- See a doctor if you think a medication is worsening symptoms such as a change in medication may be an option. Some medicines worth considering include: aspirin, anti-inflammatory analgesic, codeine, and angiotensin converting enzyme (ACE).
Steroids may reduce inflammation and relieve hives. However, there is a common treatment because of serious side effects that can occur if you take steroids regularly. However, a short course of steroids may be advised from time to time by a bad outbreak of symptoms.
Several other treatments have been tried with varying success. One may be advised by a specialist. For example:
- Crash diets that avoid possible food triggers.
- Immunosuppressive therapy (but runs the risk of serious side effects).
- Other drugs that have limited evidence of work in most cases, but may work in some cases.
- In your case, the H pylori stomach compensation. (See separate leaflet called 'Helicobacter pylori and stomach ache ").
Treatment of angioedema associated
Antihistamines usually help reduce swelling of angio-edema. Sometimes an injection of adrenaline treatment and hospital emergency necessary if inflammation affects the throat and breathing becomes difficult.
For a list of websites that contain pictures of skin conditions including hives see www.patient.co.uk/showdoc/1097/