Hives Treatment In Singapore

Are you experiencing red, swollen and itchy skin?

While most cases of acute hives (urticaria) lasts for hours to days, chronic hives can last for years.

hives on shoulder and back
Hives on shoulder and back

Table of Contents

What are hives (Urticaria)?

Hives, medically referred to as urticaria, represent a common dermatological condition characterized by the sudden appearance of raised, red, and itchy welts on the skin. These welts, also known as weals, can vary in size and may join together to form larger areas of swelling. Urticaria can be acute, resolving within six weeks, or chronic, persisting beyond this period and often recurring over months or years.

What causes hives?

Hives or urticaria are caused by the release of the chemical histamine from mast cells and basophils. One of the action of histamine is to dilate the blood vessels, making it more leaky and thus filling the surrounding tissue with fluid. The expansion of fluid in the tissue leads to the characteristic redness and swelling seen in urticaria.

While the exact cause of hives remains unknown in most cases, it can be attributed the following:

  • Acute viral/bacterial infection e.g. COVID-19
  • Food allergy
  • Drug allergy
  • Vaccinations
  • Insect bites
  • Autoimmune diseases
  • Sun/Heat/cold
  • Vibration/pressure
  • Tight clothing

Who gets hives?

More than 20% of children or adults will get an episode of hives at least once in their lifetime.

Acute hives are rare in newborn and infants. Children normally will present with hives after a viral illness. In teenagers, it may be due to medications, inhaled allergens or food allergen. In adults, most cases of hives are spontaneous without any underlying cause.

How are hives diagnosed?

Diagnosis of urticaria primarily relies on clinical evaluation and patient history, with emphasis on identifying potential triggers. Laboratory tests may be indicated to rule out underlying systemic conditions or autoimmune disorders in chronic cases.

A flares of hives typically last less than 24hours, and can be classified as either acute or chronic.

  • Acute urticaria: less than 6 weeks, self-limiting
  • Chronic urticaria: more than 6 weeks, episodic  in nature

What is chronic urticaria?

Chronic urticaria is a condition characterized by the recurrence of hives (urticaria) for six weeks or longer. These hives manifest as red, itchy welts on the skin, which can vary in size and may merge to form larger areas of swelling. Unlike acute urticaria, which typically resolves within a short period, chronic urticaria persists and often has a significant impact on the quality of life due to its long-lasting and unpredictable nature.

While most cases are spontaneous and do not have an underlying cause, potential factors include:

  1. Autoimmune Disorders: Chronic urticaria is sometimes associated with autoimmune conditions, where the immune system mistakenly attacks the body’s own tissues, releasing histamine and other chemicals that cause hives.
  2. Infections: Chronic infections, such as Helicobacter pylori, may be linked to persistent hives.
  3. Allergies: Although less common, chronic urticaria can be triggered by persistent allergic reactions to foods, medications, or environmental factors.
  4. Physical Factors: Physical urticarias are a subset where hives are triggered by physical stimuli like pressure, cold, heat, exercise, or sunlight.
  5. Stress: Emotional stress and anxiety can exacerbate or trigger symptoms.

What are Physical urticarias?

dermographism on arm
Dermatographism

Physical urticaria is a subset of chronic urticaria triggered by specific physical stimuli. Each type is characterized by its unique triggers and presentation. The main types include:

  • Dermatographism: scratch or stroking the skin
  • Cold urticaria: cold air, cold water, ice
  • Hot urticaria: hot drink, hot water bottle
  • Cholinergic urticaria: exercise, sweat, hot shower
  • Contact urticaria: saliva, latex, cosmetics
  • Delayed pressure urticaria: caryying heavy bag, seat belt
  • Solar urticaria: UV or visible light
  • Vibratory urticaria: Jackhammer
  • Aquagenic urticaria: fresh, salt or chlorinated water

How are hives treated?

Management strategies for urticaria aim at symptom relief and addressing the underlying cause when identified. First-line treatment typically includes antihistamines, which help mitigate the histamine-mediated response.

Second generation anti-histamines for hives are usually the first line treatment:

  • Cetirizine
  • Levocetirizine
  • Loratadine 
  • Fexofenadine
  • Bilastine

For refractory or severe cases, additional therapeutic options such as short term corticosteroids, leukotriene receptor antagonists, Doxepin (an anti-depressant) or immunosuppressive agents may be considered. Emerging biologic therapies, like omalizumab, have shown promise in treating chronic spontaneous urticaria unresponsive to conventional treatments.

Frequently Asked Questions

No, hives are not contagious. They are a reaction of the body’s immune system and cannot be spread from person to person.

Yes, emotional stress and anxiety can trigger or exacerbate hives in some individuals. Stress management techniques can be helpful in such cases.

While hives are often benign and self-limiting, they can sometimes be a sign of an underlying condition such as an autoimmune disorder, infection, or thyroid disease. Anaphylaxis, a severe allergic reaction, can also present with hives and requires immediate medical attention.

If you get hives, try to identify and avoid any potential triggers. Over-the-counter antihistamines can help reduce symptoms. If hives persist, are severe, or are accompanied by symptoms like difficulty breathing or swelling of the face and throat, seek medical attention immediately.

 

Preventing hives involves avoiding known triggers, such as specific foods, medications, or environmental factors. For individuals with chronic urticaria, maintaining a healthy lifestyle and managing stress can help reduce the frequency and severity of outbreaks.

Hives (urticaria) and eczema (atopic dermatitis) are both common skin conditions, but they have distinct characteristics and causes. While they can coexist in the same individual and share some similarities, they are fundamentally different disorders.

You should see a doctor if your hives are severe, persistent, or accompanied by other symptoms such as difficulty breathing, swelling of the face or throat, or signs of infection. Chronic hives lasting more than six weeks should also be evaluated by a healthcare professional.

Hives can be triggered by viral, bacterial and parasitic infections. Common infections include  Epstein-Barr virus, hepatitis (A, B, and C), and herpes simplex virus. Strep throat infections can cause hives in children. Lesions caused by insect bites can last longer than 24 hours. Urticarial reactions to penicillin can occur up to 14 days after a course of treatment has stopped.

Swelling is likely to present on the face, genitalia, trunk, and extremities of patients, with the vast majority experiencing face, hand, and foot involvement. Lesions commonly last 20-180 minutes, resolve, and then reappear in other areas. An entire urticaria episode often lasts 24-48 hours, with individual lesions typically fading in about 24 hours. Rarely, acute urticaria can last 3-6 weeks, but scars do not develop. Tiny pinpoint hives are characteristic of cholinergic urticaria. Permanent hyperpigmentation or hypopigmentation does not occur.

Hives Insight

Hives, though often benign and self-limiting, can significantly impact quality of life. A comprehensive, patient-centered approach to management is crucial in alleviating symptoms and improving the well-being of affected individuals.

Schedule a consultation for hives treatment in Singapore

While acute urticaria often resolves spontaneously, chronic urticaria can persist for months or years, significantly impacting the patient’s quality of life. With appropriate management and follow-up, most patients can achieve good control of symptoms. Contact us today for a medical assessment.

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References:
  1. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J. The diagnosis and management of acute and chronic urticaria: 2014 update. Journal of Allergy and Clinical Immunology. 2014 May 1;133(5):1270-7.
  2. Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer‐Weber B, Bangert C, Ben‐Shoshan M, Bernstein JA, Bindslev‐Jensen C. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022 Mar;77(3):734-66.

ABOUT DR MOSES NG

Dr Moses Ng dermatologist

MBBS (London) with distinction
Dip Practical Dermatology (Cardiff) with distinction
Member of American Acne & Rosacea Society
Fellow of American Society for Laser Medicine & Surgery

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Dr. Moses Ng is a distinguished professional in the field of aesthetic medicine, renowned for his expertise in advanced cosmetic procedures. With over 15 years of experience, extensive training and a keen eye for detail, Dr. Ng specializes in a wide range of treatments, including injectables, laser therapies, and acne scar management.

Dr. Moses Ng’s commitment to excellence and patient-centric approach have earned him a reputation as a trusted clinician in aesthetic medicine. His continuous pursuit of the latest advancements in the field ensures that his patients receive the highest standard of care and the most effective treatments available.

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