URTICARIA

Overview and Facts

Urticaria or hives is characterized by the sudden appearance of swollen red bumps on the skin. It results from the body’s immune response to allergens or, in some cases, for unknown reasons.

Hives are usually itchy, however, they can also sting or burn. They can manifest on any location on the body which includes the ears, face, throat, tongue, or lips. They have variable size and can coalesce to form plaques. They could last for hours to a day before getting resolved.

Types and Symptoms

TYPES

There are several different types of hives, these include:

Acute urticaria: These are hives that last less than six weeks. Its causative agents are infections, medications, and certain foods. Insect bites and internal diseases, however, may also cause this type of urticaria.

Drugs such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, antihypertensives, and opiates can cause hives and angioedema.

Chronic urticaria and angioedema: As the name implies, these are hives that last for more than six weeks. In most cases, the causative agent/s may be impossible to identify. Symptoms include muscle soreness, vomiting and diarrhea, and shortness of breath.

Physical urticaria: When the skin undergoes direct physical stimulation e.g. exercise, sweating, pressure, vibration, sun exposure, heat, and cold, it causes hives. At the site of stimulation, hives usually occur. Most of the hives appear one hour after exposure to the stimulus.

Dermatographism: It is a form of urticaria wherein it occurs whenever you stroke or scratch your skin.

TYPES

Other common types of leg ulcer include:

Arterial leg ulcers
Diabetic leg ulcers
Malignant leg ulcers
Traumatic leg ulcers
Vasculitic leg ulcers

Ulcers in the foot are usually caused by diabetes.

SYMPTOMS

Itching, pain, and swelling in the affected leg are characteristic symptoms of a venous leg ulcer.

Discoloration, hardening of the skin around the ulcer, and presence of a foul-smelling discharge may also be present when you have a venous leg ulcer.

If you have a venous leg ulcer, you may exhibit the following conditions:

discoloration and darkening of the skin around the ulcer
swollen ankles
red, flaky, scaly and itchy skin on your legs
swollen and enlarged veins on your legs
hardened skin around the ulcer, which may make your leg feel hard
a heavy feeling in your legs
an unpleasant and foul-smelling discharge from the ulcer
aching or swelling in your legs

Signs of an infection

Opportunistic pathogens could cause secondary bacterial infections due to the ulcer.

Symptoms of an infected leg ulcer may include:

a green or unpleasant discharge coming from the ulcer
fever
redness and swelling of the skin around the ulcer
worsening pain
an unpleasant smell coming from the ulcer

Diagnosis & Medications

DIAGNOSIS

Your doctor may ask several questions to find the causative agent of your hives. No specific tests will be necessary.

Skin tests may be done to find out what substances you are allergic to. Routine blood tests may be performed in some cases to rule out infections.

TREATMENT

The best treatment for hives and angioedema is the identification and removal of the trigger; however, this may be a daunting task. Antihistamines are usually prescribed to provide relief for your symptoms.

Chronic hives may also be treated with a combination of medications or antihistamines. Glucocorticoids, drugs that reduce inflammation and at the same time suppress the immune system, are prescribed if antihistamines don’t work. Omalizumab, a whole antibody-drug, is FDA approved to treat chronic hives in individuals.

For severe hives, an epinephrine injection or a cortisone medication may be warranted.