Hives (urticaria) is a common inflammatory skin condition in which raised red or white welts appear on the skin. The welts can often disappear and reappear; some last for a few minutes, while other welts may stick around for 24 hours. The welts disappear only to be replaced by others. Hives can either be acute, lasting less than 6 weeks, or chronic. Hives can appear anywhere on the body, including the lips, tongue, throat and face. In cases where there is swelling around the eyes and lips, as well as inside the mouth, the condition is called angioedema. Depending on severity, welts can spread, increase in size and join together to cover large areas of skin. They can often be very itchy and can sting or burn. The exact cause of hives is unclear, but there are many factors that can lead to flare-ups such as a response to medications, infection or certain foods. Other people may get hives from exposure to cold or hot temperatures, sun exposure, physical skin pressure or rubbing of the skin. Stress may also trigger an outbreak of hives. Successful treatment can be difficult, due to the spontaneous nature of the reaction. The best defense is to be aware of potential triggers and avoid them if possible.

Common symptoms of hives include:

Welts: Raised, red welts appear on the skin.

Rash: An itchy rash that may spread to other areas of the body.

Pain: Stinging or burning sensation in the affected area.

The exact cause of hives is often not fully understood, and it may be triggered by a variety of factors such as extreme hot or cold climate, stress, sun exposure, foods, pet dander, medication, infection, pollen or illness. Whatever the cause, it results in the release of histamine and histamine-like substances from cells called “mast cells” in the dermis. These cells have multiple receptors, that when activated, permit the discharge of the products contained in tiny packages in the skin. Substances that are released into the bloodstream, such as histamine, allow blood vessels in the dermis to dilate, creating a red appearance and also causing water to leak into the skin, which produces swelling.

Because of the sensitive and inflammatory nature of this condition, take care when choosing skincare products. Avoid soaps, especially bar soaps, as they will cause dry skin and may damage the skin barrier. Instead, opt for mild soap-free cleansers, preferably in liquid form. These cleansers will gently remove dirt, excess oil, bacteria and cosmetics without damaging the skin barrier. Be careful to limit contact with hot water, as this can actually dry out the skin further. Moisturizers help to restore and maintain the skin’s natural moisture levels. Look for a moisturizer specially designed for sensitive skin that is free of fragrance, dye or other allergens that may irritate the skin. Frequent application of moisturizing creams can help soothe dry and itchy spots.If itching is severe, do not scratch the affected area, as it can lead to scarring, increased pigmentation (darkening of the skin), thickening of the skin, or infection. Instead, gently pat the skin, or apply a damp compress for relief.

Overall, the best way to prevent hives is to identify and avoid the specific factors causing the reaction. Be sure to choose cleansers and moisturizers for sensitive skin, and sunscreens that are free of fragrance and dye. If you do come into contact with an allergen, avoid scratching, and don’t use any harsh soaps or detergents that may dry the skin. If you’re unsure of what’s causing the irritation, an allergist can help you find out the source, and how to effectively treat it.

The most important step is to try and identify the source of the hives. This is done by taking a careful history, examination and a variety of lab tests.

Taking an oral antihistamine can often help reduce the symptoms of hives. These medications are effective in blocking the histamine receptors in the skin (which produce the symptoms). Diphenhydramine (Benadryl) is considered one of the most effective medications for treating hives, but can cause drowsiness. A doctor may suggest non-sedating antihistamines such as Cetirizine (Zyrtec), Fexofenadine (Allegra) or Loratadine (Claritin).

If the cause of the hives is known, a doctor may prescribe oral corticosteroids to help relieve swelling redness and itching.. In cases of chronic hives, prolonged use of oral steroid could be associated with significant side effects. There are a number of prescription antihistamines that are helpful. Some of them can be sedating, which at least can give relief from intense itching and discomfort.