Urticaria, commonly known as hives, is a skin condition marked by the sudden appearance of raised, itchy swellings on the skin. These occur when cells in the skin release substances such as histamine, causing small blood vessels to leak fluid into surrounding tissue. This leads to temporary swelling, redness, and itch, with welts that may appear and fade over short periods of time. Urticaria can also be accompanied by angioedema, with swelling of the eyes and/or lips.
In the majority of patients, histamine release may occur without a clear allergic trigger and can be influenced by factors such as infections, medications, stress, or physical stimuli. In a small percentage of patients, histamine release can be triggered by an allergic response to specific proteins known as allergens.
At Auria Dermatology Clinic, we assess and manage different forms of urticaria. A careful clinical evaluation helps identify potential triggers and guides appropriate management.
Acute urticaria refers to hives that are present for less than six weeks. Episodes often develop suddenly and may resolve within hours or days, although new wheals can continue to appear during this period.
Raised, itchy swellings may appear anywhere on the body and often change in shape or location. In some individuals, swelling may also involve deeper tissues such as the lips or eyelids. The abrupt onset and recurrence over several days can be unsettling.
Acute urticaria is commonly associated with:
Food-related triggers can occur but are not the most frequent cause.
Management focuses on relieving symptoms and may include:
Chronic urticaria is diagnosed when hives occur on most days for more than six weeks. Symptoms may persist for months or longer and often follow a fluctuating course.
Hives typically resolve within 24 hours but recur repeatedly, sometimes in different areas. Persistent itch and unpredictability of flares may affect sleep, concentration, and daily routines.
In many individuals, chronic urticaria is not linked to a specific external allergen. Immune-related mechanisms are thought to play a role. Factors that may worsen symptoms include:
Food is not usually a primary trigger in chronic urticaria.
Management is individualised and may include:
Treatment response is reviewed over time, and management plans are adjusted as needed.
Inducible urticaria occurs when hives are triggered by specific stimuli rather than appearing spontaneously.
Hives develop shortly after exposure to triggers such as physical pressure, cold, heat, exercise, sweating, or sunlight. Symptoms usually settle once the trigger is removed but may recur with repeated exposure.
Triggers vary between individuals and may include:
Management may include:
Angioedema refers to deeper swelling of the skin and underlying tissues and may occur together with urticaria or on its own. It commonly affects the lips, eyelids, face, or hands.
Swelling may feel tight or uncomfortable rather than itchy and often takes longer to resolve than surface hives. Facial swelling commonly causes concern due to its appearance.
Angioedema may be associated with:
Management depends on the underlying cause and may include:
Prompt medical attention is advised if swelling affects breathing or the throat.
You may consider seeking medical advice if:
A consultation with Dr Laura Hui allows for accurate diagnosis and discussion of suitable management options.
Diagnosis is usually based on medical history and skin examination. Assessment may include:
Investigations are not routinely required but may be considered in chronic or atypical cases to assess for underlying conditions.
