Have you ever noticed that sometimes you suddenly get red, slightly itchy bumps on your body? Sometimes they itch a lot, sometimes they hurt a little. Sometimes they go away in a day or two, but for some people, these bumps can last for weeks or months. That's the kind of condition we're going to talk about today.
So what are these incurable hives or chronic hives?
Simply put, chronic hives are itchy, red, raised bumps or welts on your skin that appear at least twice a week. These welts, also called `wheals`, are considered `chronic' or `persistent' when they last for more than six weeks .
You may have heard this condition called ``Chronic Idiopathic Urticaria.'' Let's understand that a little, shall we?
- Chronic: A symptom or condition that persists despite treatment. That is, something that does not get better on its own after a while.
- Idiopathic: A symptom or condition that occurs suddenly, without any apparent cause. The exact cause is difficult to determine.
- Urticaria: This is the medical name for hives. It is pronounced like 'er-ti-care-ree-ya'.
What are Urticaria and Angioedema? What is the relationship between the two?
Hives, also known as urticaria, and angioedema can occur together. Hives are red bumps or spots that appear on your skin. Angioedema can sometimes occur in the deeper layers of your skin. This swelling can affect your face, lips, throat, hands, feet, and genitals. For example, sometimes hives can be accompanied by swollen lips. If your throat swells, it can also make it difficult to breathe, so it's important to seek medical advice immediately.
What is the difference between normal hives and chronic hives?
Chronic hives are different from the more common ``acute hives''.
- Acute Hives: These usually start to disappear within 24 hours (but new ones may appear). However, they usually disappear completely within six weeks. These are often caused by something like a recent viral infection or a food allergy.
- Chronic Hives: These are hives that occur for more than six weeks, at least twice a week. Some chronic hives can last for months or even years. The sad thing is, most of the time, there is no known cause. That means it's not because you ate something wrong.
How common is this condition called Chronic Hives?
About 5% of the world's population can develop chronic hives. That means five percent is a lot, right? This condition can develop in anyone of any age, regardless of gender. However , it is slightly more common in women between the ages of 30 and 50. The exact cause is not clear, but it may be related to factors such as hormonal changes.
What are the causes of chronic hives?
In fact, many people with chronic hives have no clear cause. That's what we called 'idiopathic'. Rarely, they are caused by allergies to certain medications or foods. If they are, they are most often caused by something you eat or drink regularly. For example, some people may be allergic to preservatives or artificial colors.
Not only that, some people can get hives when their body temperature changes suddenly, such as when they are very hot, very cold, or when they exercise. Sometimes, this condition can also be caused by the pressure on the skin caused by wearing tight clothing. For example, some people get hives when they take a cold shower (`cold urticaria`), while others get hives when they sweat and get hot (`cholinergic urticaria`). Some people can also get hives when they go out in the sun (`solar urticaria`).
Do autoimmune diseases also cause chronic hives?
Yes, that's possible. About one in five people with chronic hives, or about 20%, have been found to have another 'autoimmune disease'. That is, a disease in which the immune system attacks the body's own cells. In such cases, the body can produce 'antibodies' against its own skin cells, causing these lesions.
To give a few examples:
- Celiac disease (an allergy to the protein gluten)
- Dermatomyositis (a disease affecting the skin and muscles)
- Diabetes (especially type 1 diabetes)
- `Lupus`
- Polymyositis (a disease that affects the muscles)
- Rheumatoid arthritis (that means joint pain)
- Thyroid disease (especially Hashimoto's thyroiditis)
- Vitiligo (white patches on the skin)
What other diseases can cause chronic hives?
Chronic hives can also be caused by other medical conditions. Although these are not very common, a doctor will consider these as well.
- `Asthma`
- Infections, for example, bacterial infections such as H. pylori (which can also cause stomach ulcers) and chronic infections such as sinusitis.
- `Liver disease`
- Types of cancer called `Lymphomas`, that is `Hodgkin lymphoma` and `non-Hodgkin's lymphoma`
- Vasculitis (inflammation of the blood vessels)
What are the symptoms of Chronic Hives?
These lesions can appear anywhere on the body, and the way they look can vary from person to person. These lesions can come in a variety of shapes and sizes. Some can be as small as a pinhead, while others can be as big as a softball!
The main symptoms of chronic hives are:
- Red, raised, and possibly painful or inflamed lesions or bumps on your skin.
- Blanching: This means that the center of the blister turns white when pressed. This can be used to distinguish it from a common mosquito bite.
- Excessive scratching of the skin (also called `pruritus`). This itching is what makes it difficult for many people to tolerate, especially at night.
- Swelling, that's what we talked about earlier, called 'angioedema.' This can occur around the eyes, lips, and limbs.
What kind of doctor should I see for chronic hives?
There are several doctors who can diagnose and treat this chronic hives condition:
- Allergists: Because sometimes this can be related to an allergy.
- Dermatologists: Because they have special knowledge about skin diseases.
- Your family doctor (primary care physicians): He or she can perform a basic examination and refer you to a specialist if necessary.
How is this condition of Chronic Urticaria accurately diagnosed?
Your doctor can diagnose this condition by examining your skin and asking about your symptoms, whether anyone in your family has similar conditions, the medications you take, and your eating habits.
To find out exactly what is causing your chronic hives (or to rule out some causes), you may need to have several tests done. You may need to do one or more of the following:
- Allergy test: To see if you have a reaction to an `allergen`, that is, something that causes an allergy. This may be a `skin prick test` or a blood test.
- Blood tests: Check the body's antibody levels (especially IgE levels), markers of inflammation, thyroid hormone levels, and antibodies related to autoimmune diseases.
- Urine test: Check for bacterial infections.
- Skin biopsy: A small piece of skin is taken to confirm the diagnosis and to rule out other rare causes, such as vasculitis. This is usually done if the lesions are unusual or not responding to treatment.
What are the treatments for chronic hives?
Fortunately, there are treatments for these chronic hives. The goal is to control the symptoms and allow you to live a normal life.
- Allergy medications: Medications such as antihistamines, which can be taken daily, over-the-counter (OTC) or prescribed by a doctor, can help reduce itching and reduce or prevent allergic reactions. Sometimes, your doctor may prescribe a higher dose than usual.
- Allergy shots: Omalizumab (Xolair®) is a monthly injection that blocks the body's production of a protein called Immunoglobulin E (IgE). People with severe allergies may produce too much of this IgE, which can lead to problems like chronic hives and asthma. Although this is a more expensive treatment, it is very effective for people who have not responded to other medications.
- Steroids: Corticosteroids, such as Prednisone (Deltasone®, Rayos®), can quickly control symptoms that have not responded to other medications, especially severe flare-ups. However, these should not be used continuously and should only be used for a short period of time, as prescribed by a doctor. Long-term use can cause side effects.
- Hydroxychloroquine: One study found that eight out of ten people with chronic hives caused by an autoimmune disease had a reduction in symptoms after taking the malaria drug hydroxychloroquine (Plaquenil®) for three months or more.
- Cyclosporine: This is an immunosuppressant. It is very effective in treating severe chronic hives. However, it can cause serious side effects when taken for a long time, so it should be used under the close supervision of a doctor.
The most important thing is to talk to a doctor about whether this treatment is right for you and how long you need to take it. Don't just take medication on your own.
What can you do at home to get relief from these symptoms?
Yes, you can try these things at home to reduce itching and inflammation:
- Apply an OTC anti-itch cream from the pharmacy. You can use things like calamine lotion.
- Place cool compresses soaked in cold water on the rash several times a day (but remember, don't do this if the rash is getting worse due to the cold – that is, if you have `cold urticaria`).
- Take a cold shower or bath. Taking a hot shower can make the itching worse.
- Moisturize dry skin with hypoallergenic lotions and creams. Choose a simple, unscented moisturizer.
- Wear loose-fitting clothes made of soft cotton that won't irritate your skin. Wearing tight clothes can make the condition worse. Avoid wearing clothes made of rough fabrics like wool.
- Avoid scratching as much as possible. While scratching may provide temporary relief, it can actually damage the skin and cause further damage.
Can these chronic hives last for years?
About half, or 50%, of people with chronic hives will have their hives go away within a year (often without treatment). Another 20% will have their hives gone within five years. But for some people, it can last even longer. Treatment for long-term hives can help relieve symptoms. So don't worry, there are treatments.
When should I definitely see a doctor?
If you have any of these things, definitely see a doctor:
- If the bruise or swelling lasts more than a week.
- If the wound looks infected (i.e. red, swollen, pus-filled, or has a fever).
- If the pain recurs every few months.
- If you scratch your skin unbearably, it can interfere with your sleep and daily activities.
- If you have difficulty breathing, feel like your throat is constricted, or feel dizzy, it is an emergency. Go to a hospital immediately.
What should I ask the doctor?
It's a good idea to ask these questions when you see your doctor:
- What causes these chronic hives? Or, what do you think could be causing them?
- When will these chronic hives get better?
- Should I get an allergy test?
- What is the best treatment for me for these chronic hives?
- What is the best treatment to reduce itching?
- Are there any side effects to this medicine?
- What complications should I be concerned about?
- Do I need to make changes to my diet and lifestyle?
Can chronic hives be caused by stress or anxiety?
In fact, stress and anxiety can make skin conditions worse. That is, stress can make the skin worse and itchiness worse. Therefore, sometimes anti-anxiety medicines can help. You can also benefit from things like meditation, mindfulness, yoga, and getting enough sleep to calm your mind. Remember, a happy mind is very important for a healthy body.
So, what are the things we need to remember from all of this? (Take-Home Message)
Chronic hives (Chronic Urticaria) can be really itchy and uncomfortable. Sometimes you can even feel upset about your appearance. Although doctors often can't pinpoint the exact cause of chronic hives, medications like antihistamines, steroids, and sometimes even immunosuppressants can help. There are also things you can do at home to help reduce the itching and swelling.
The important thing is that for many people, chronic hives go away on their own over time (perhaps even after a year or more). So stay strong and follow your doctor's advice. You are not alone, and there are doctors who can help you get over this condition. There are treatments that can improve your quality of life.
` Rash, chronic hives, urticaria, skin diseases, itching, allergies, angioedema
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