What are the treatment options for hives?

Q. I have been plagued by hives for months. After each episode, the affected areas are left with bruise marks. They look like the bark of a tree trunk.

I am 31, exercise regularly and do not have any major health issues.

However, I had an episode of Bell's palsy four years ago. But I do not think it is related.

The doctor prescribed oral medication as well as a cream. However, the treatment doesn't seem to work.

Should I be concerned about this?

A. Hives or urticaria appear as swollen red, itchy wheals anywhere on the skin.

It is an extremely common condition, affecting approximately 20 to 30 per cent of people at some time during their lives.

There are two main groups of urticaria.

Acute urticaria, in which symptoms last fewer than six weeks, and chronic urticaria, where symptoms last or recur more than six weeks.

Why the distinction? Acute urticaria normally has a detectable cause, such as an allergy to food or medication, or viral infection.

Chronic urticaria is normally of an unknown cause and many cases may be due to autoimmunity (where antibodies found in the blood attack one's own mast cells, resulting in the release of histamine, which causes the symptoms of urticaria).

Investigations are often performed in chronic cases to exclude illnesses which may be causing the urticaria.

Hives do not normally leave marks on the skin after they fade. However, because the rash is itchy, scratching hard may cause bruising of the skin, thus leaving marks.

If, however, the marks are not due to bruising, we may have to consider the possibility of urticarial vasculitis, a condition which is due to inflammation of blood vessels.

This condition, which is different from urticaria, shows up as hives which cause pain and leave marks.

A skin biopsy is required to confirm this diagnosis and it is normally harder to treat compared with urticaria.

Treatment of hives involves the use of oral antihistamines. This is generally adequate to control symptoms, but severe cases may require short courses of oral steroids.

In acute cases, removal of the offending agent is often curative.

As you are suffering from chronic urticaria, I would advise you to consult a dermatologist who will assess your condition, recommend appropriate tests and prescribe the necessary oral medication to control your symptoms.

Do understand that doctors cannot "cure" chronic urticaria, but can only prescribe treatment to help control its symptoms.

Most cases of chronic urticaria will, however, resolve on their own after a period of time.

Consultant dermatologist in the Raffles Skin & Aesthetics Centre

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