Hives, or itchy skin welts, cause many people great distress. “They are extremely uncomfortable no matter how big or small they are,” says Dr. Jeffrey Ross Gunter, a dermatologist at SummitMD Dermatology. “To help my patients, I first determine the cause of their hives, which will help minimize their outbreaks, and I then create a personal treatment plan so that my patients can have the relief they desperately need.”
Dr. Gunter explains that there are two types of hives: acute, which lasts less than six weeks, and chronic, which lasts longer. “An especially dangerous form of hives is angioedema, which happens when the welts occur deep under the skin. The patient’s lips and eyelids swell, and in this situation, they must seek immediate emergency care.”
The patient’s hives can vary in size, shape, color, and location. “They are typically either flesh-colored, pink, white, or red,” Dr. Gunter says. “They may be six or seven inches in diameter or as small as a pencil mark. Either way, they pack a very powerful itch that is miserable for the patient. Thankfully, they usually don’t last longer than a few hours. Some of my patients have been fortunate to never experience more than one flare-up while others have had them for years.”
Dr. Gunter recommends that anyone with chronic hives see a dermatologist. “It’s important to determine the cause of the hives, which could be a disease like diabetes or rheumatoid arthritis. There are also medications and infections that could be the culprit. Other possibilities include insect bites, pressure on the skin, and foods, including nuts, shellfish, bananas, mangos, and eggs.”
To determine the source of your hives, he suggests keeping track of when they occurred, how long they lasted, and what you ate prior to their breakout. “Also be sure to note what kinds of medication you’ve been taking, including aspirin and Ibuprofen; what you drank before the hives appeared, including water; and the names of any skincare products, cosmetics, or toothpaste you have been using,” Dr. Gunter states. “Any detail could be important. Something as seemingly minor as how hot or cold it was or if you visited a tanning bed could point to the reason your hives erupted.”
It can be hard to focus on anything other than relieving the discomfort when you are in the middle of a breakout, but if possible, Dr. Gunter directs people to take pictures of their hives. “It is possible that by the time you arrive at the dermatologist, the hives will have cleared, so having the photos will help your doctor diagnose them.” For those unable to quickly see a dermatologist, Dr. Gunter has some suggestions for getting relief from the itch. “Keep cool if you can. Getting overheated will only make the itching worse. You can try wearing cotton clothes that fit loosely, and, unless cold is your trigger, place a cold compress on the welts. Calamine lotion can reduce the itch, and using a moisturizer several times each day will keep your skin from drying out and making the hives even worse.”
He also recommends being sure to not put pressure on the hives. “This is especially important for women who carry purses and for people who have a backpack. The pressure of the straps will only aggravate the hives and intensify the itch.”
Dr. Gunter has also seen his patients’ symptoms lessen because of a reduction in stress. “Meditation and daily exercise are both great ways to lower your stress level and decrease the risk of your hives returning,” he says.
Despite the dermatologist’s efforts, it’s possible that a patient may never know what causes their hives. “It’s frustrating, but even without knowing the cause, the hives can still be treated effectively,” states Dr. Gunter. “In fact, the main reason treatments do not work is because patients do not follow their treatment plan or because they do not tell their dermatologist that the treatment is not working. Good communication between the patient and their doctor can go a long way toward managing flare-ups.”
The good news, Dr. Gunter says, is that even chronic hives do not automatically mean a lifetime of outbreaks. “I have seen about half of my patients stop having them completely within a year, so that is very promising. Getting hives does not have to mean that your life will completely change. With medication and a few lifestyle changes, you can avoid the flare-ups and go on with your daily activities without that bothersome itch.”
Jeffrey Ross Gunter, MD, FAAD is a board-certified dermatologist at SummitMD Dermatology. He is a graduate of the Keck School of Medicine at the University of Southern California where he was previously a Clinical Professor of Dermatology and Chief Resident of Dermatology at the LAC/USC Medical Center in Los Angeles, CA.