5 Dermatologist Tips for People With Chronic Hives

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    Understand Your Chronic Hives
    Hives, also known as urticaria, refers to a red or swollen skin reaction that can be either localized or widespread. Hives tend to be very itchy and usually last less than a day (acute hives). In more severe instances, hives can last more than six weeks, which can be pretty miserable for patients. We call this condition chronic hives. Knowing how to identify the various types of hive reactions is the first step towards initiating a successful treatment and prevention plan.
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    1. Don’t wait too long to see a doctor.
    Many of my patients don’t think their hives are a big enough deal to go to the doctor. But when hives have lasted for more than a couple of weeks, it’s time to see a either a dermatologist or allergist for an evaluation–the earlier, the better. Additionally, if your hives are burning or painful, it’s smart to get checked out immediately as this could be a sign of urticarial vasculitis, a more serious condition caused by inflamed blood vessels. Hives due to this latter condition can be associated with kidney disorders or lupus.
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    2. Work with your doctor to identify a cause.
    With acute hive reactions, we can often narrow the cause down to a specific issue such as an allergic reaction to a medication or recent infection. With chronic hives, the trigger isn’t always clear. However, it’s important to determine if a chronic hive reaction is being caused by a serious illness such as a thyroid disorder or hepatitis. I’ve even seen hives caused by a dental abscess or contaminated meal overseas. Identifying and treating these underlying causes will usually relieve your hives and help to improve your overall health. Sometimes, despite our best efforts, no specific cause or trigger can be found for a hive reaction; this is called chronic spontaneous urticaria. In these instances, we can prescribe medications that will alleviate symptoms and help to limit or prevent new outbreaks.
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    3. Be prepared to try a few medications.
    To treat acute hives, we’ll typically prescribe one or two antihistamine medicines; however, with chronic hives, this often isn’t enough. For these cases, we need to initiate more aggressive medications such as zafirlukast (Accolate) or oral corticosteroids in order to reduce skin inflammation. Another injectable medication, called omalizumab (Xolair) is approved by the Food and Drug Administration (FDA) for use in chronic spontaneous hive cases; I use it for my most difficult patients. Omalizumab is delivered via a series of monthly injections to keep hives away long term.
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    4. Keep track of symptoms.
    When experiencing hives, it’s crucial to understand what’s going on with your body. One way to do this is by keeping a diary of your symptoms and asking questions like: Has the intensity of my hive reactions increased? Have they spread further than in the past? How long do they last? Do they occur after a hot shower? Are they showing up when cold weather comes around? It's also important to make note of any additional symptoms, like shortness of breath, fatigue, or dizziness. Finally, keep a detailed record of your diet and medication usage in case something you’re ingesting orally is the culprit. Good detective work may serve you and your doctor well to determine both the exact cause and what steps you can take to reverse the process.
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    5. Be kind to your skin.
    We may not always know what causes chronic hives, but we do know that respecting the skin and using “skin-friendly” items is a must. If you’re prone to hives, avoid fragranced or dyed lotions and creams, take lukewarm (not hot) showers, and make sure to keep the skin hydrated with moisturizers! Keeping moisturizers or prescription creams in the refrigerator can alleviate itch and calm irritated skin. Cold, by itself, can also reduce unwanted swelling and redness. Ask your dermatologist or allergist for more tips on how to keep your skin looking and feeling its best.
Chronic Hives | Dermatologist

About The Author

Dr. David Harvey, FAAD, FACMS, is a dermatologist and Mohs surgeon with Piedmont Healthcare and the Dermatology Institute for Skin Cancer and Cosmetic Surgery.
View his Healthgrades profile >
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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.