DEAR DR. GOTT: I have these spots that keep breaking out. The doctor told me it was urticaria. Can you tell me something about it, how I can get rid of it and what causes it to keep coming and going away? When the spots come, they burn from the inside out and they break and turn red on the outside of my skin.
The doctor gave me pills to take but they didn’t help. This has been going on for the last 2 ½ years. At first I though it was caused by nerves but I haven’t had any problems recently.
DEAR READER: Urticaria, otherwise known as hives, is itchy, red (or sometimes white), raised welts that appear on the surface of the skin. They can change shape and disappear, only to reappear again and again. They may enlarge, spread and join together to cover a greater area of the body, lasting less than an hour or as long as a few weeks.
Hives can be triggered by such things as exposure to specific medications, food or food additives, insects, animal dander, infection or parasites. In some instances (although rarely), stress and autoimmune disorders that may be linked to other health problems such as a thyroid abnormality or lupus, may be the culprit. Testing by an allergy specialist may be extremely helpful in ruling out some of the more common possibilities believed to be the cause. Whatever the trigger, hives develop when an allergic reaction occurs and the body releases histamine and other chemicals into the bloodstream, resulting in itching, redness, irritation and the complaints you experience. Symptoms may not always be present with each outbreak.
Diagnosis is generally made through visual examination by a physician. When any question remains, a skin biopsy can be performed for clarification.
Treatment for the disorder depends on the severity of the condition. If your complaints are generally mild, nothing may need to be done. A first step for mild-to-moderate cases might be to take an over-the-counter antihistamine such as Benadryl or chlortrimeton that might cause drowsiness but should be effective. Keep in mind that an antihistamine will lessen or stop your symptoms for a time but will not treat the underlying cause of the rash. To complicate things, antihistamines are now divided into two categories, sedating and non-sedating, each available with over-the-counter options and others that require a prescription. Newer antihistamines such as Claritin, Zyrtec, Allegra and others are non-sedating and might be better tolerated for daytime use. This option might be followed by oral corticosteroids such as prednisone that should only be used short-term. Complications from extreme reactions, to include anaphylaxis that causes breathing difficulties, should be treated as an emergency with epinephrine or steroids.
On the home front, I might suggest you begin by keeping a log of your daily activities and diet, soaps and lotions used, encounters with animals, or specific substances if you experience an outbreak. It will also be beneficial to keep track of times to better determine if there is a link between a certain product or food and your hives. For example, did you take a new medication, eat a specific food, hold a cat on your lap, add an over-the-counter supplement or herb to your morning diet, or have a recent infection? Any correlation over a period of time might shed light on the cause for your outbreaks. Try avoiding the offending substance(s) and perhaps you will solve the problem. Then, avoid stressful situations whenever possible. Don’t wear tight-fitting clothing and avoid hot showers and baths. Remain out of direct sunlight and avoid temperature extremes.
Remember that hives are not harmful, simply uncomfortable, itchy, may burn and are downright frustrating. Play the detective game and help your physician or allergist help you solve the puzzle.
Readers who would like related information can order my Health Report “Allergies” by sending a self-addressed. Stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
