As the name suggests, hives resemble a nettle sting. Sometimes it starts with itching and the skin may not show anything else, but eventually small bumps appear on the skin. They change places within a day so that not even a scar remains.
A rash can appear anywhere. If the bumps are in the same place for more than a day or there is a bruise, the explanation could be urticaria vasculitis, an inflammation of the blood vessels associated with hives.
– Sometimes when a person comes to the clinic, he no longer has any symptoms. That’s why it’s worth taking pictures of the rash when it’s on, advises dermatology specialist Erja Jalonen.
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For some, hives is caused or worsened by some physical factors. Quite common is the drawing stick phenomenon, when hives appear after a while after rubbing or scratching the skin. In some people, for example, sweating, cold or heat causes hives to flare up.
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– Hives can be quickly transient or long-lasting. Lasting for a few weeks, it is relatively common, and the background is usually a sick viral infection, which can be almost asymptomatic.
For some, the infection is accompanied by hives for a few days or a couple of weeks, which calms down after the infection is over.
Quite often, however, the cause of hives remains unknown. And it is not exactly known why hives last longer. Then it can take months, sometimes even years.
Itching can take away sleep – and nerves
Urticaria is very itchy. Itching erodes the quality of life. It can hijack a night’s sleep and bring you almost to the brink of “madness”. Scratching makes the itch worse, especially if there is a scratching sensation, which is aggravated by rubbing.
Mast cells in the skin secrete a substance called histamine, which is one important neurotransmitter in itching. Scratching can increase the release of histamine.
– Even if you manage not to scratch during the day, many people scratch in their sleep at night. In the worst case, the skin may break and a skin infection may even develop, for example scabies. Sometimes the skin of a long-term urticaria sufferer may have only scratch marks when they come to the doctor.
Antihistamine or other sedative
Because antihistamines block the release of histamine, they relieve itching and are the first-line treatment for hives. Compared to allergy treatment, in urticaria sometimes up to four times the dose is needed to get itching in the armpits.
In a small proportion, antihistamines do not produce an adequate response, and then other methods are resorted to.
– Cortisone taken orally helps, but it’s a bit of a double-edged sword, because the itching and symptoms can return even stronger after the course.
If the hives are really severe, cortisone is fine, but it should not be used for a long time. Montelukast, a so-called leukotriene blocker, which is a type of asthma medicine, can also be used for itching. It can be used in combination with antihistamines.
One option is the anti-inflammatory ciclosporin, which acts through the immune system. There is also a relatively new injectable biological drug for urticaria, an IgE blocker (immunoglobulin E). The medicine is expensive, and Kela reimbursement is applied for separately.
– According to the current treatment recommendation, in difficult cases, we end up with a biological drug quite quickly, says Jalonen.
Light, cold or fat to help
Sometimes urticaria is accompanied by swelling in, for example, the eyelids, lips, tongue, pharynx or limbs. In case of swelling of the pharynx, you should go to the emergency room. Fortunately, it is quite rare.
Anaphylactic reactions are again related to severe allergies. An allergic reaction can sometimes start as hives, but severe allergic reactions also include symptoms of another organ system, such as respiratory or stomach symptoms.
In the past, and to some extent even today, UVB phototherapy is used for chronic urticaria, although it is not in the official treatment recommendation. The treatment is given in a cabinet, where you stay for a few minutes 2–3 times a week, about 15 times.
Ultraviolet light relieves skin inflammation and for some it helps. Instead, the symptoms can be aggravated by various infections, stress, intense physical exertion, alcohol and even anti-inflammatory drugs.
Expert Erja Jalonen dermatology specialist, Skin Hospital.
This article has appeared in Hyvä tervey magazine. As a subscriber, you can read all issues free of charge from the digilehdet.fi service.
Source: www.hyvaterveys.fi
