Chronic Urticaria: Symptoms, Treatments, and Management Tips - Dermatology

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Chronic urticaria, commonly known as chronic hives, is a condition characterized by the presence of itchy welts or hives on the skin that can persist for six weeks or longer. It can be a frustrating and distressing condition, particularly when it interferes with daily activities and sleep, as you've described. Understanding the symptoms, treatments, and management strategies can help you cope with this condition more effectively.


Symptoms of Chronic Urticaria
The primary symptom of chronic urticaria is the appearance of raised, itchy welts on the skin. These can vary in size and can appear anywhere on the body. Other symptoms may include:
- Itching: This can range from mild to severe and can be exacerbated by heat, stress, or certain foods.

- Swelling: In some cases, swelling may occur in deeper layers of the skin, known as angioedema, which can affect areas such as the lips, eyes, and throat.

- Redness: The affected areas may appear red or inflamed.

- Skin changes: As you've experienced, scratching can lead to skin damage, bleeding, and scarring.


Treatment Options
1. Antihistamines: These are the first line of treatment for chronic urticaria. They work by blocking the action of histamine, a substance in the body that causes allergic symptoms. Your doctor has already prescribed antihistamines, which can help reduce itching and the appearance of hives.

2. Corticosteroids: While effective for short-term relief, long-term use of corticosteroids can lead to side effects, such as weight gain and water retention, which you've noted. It's important to use these under strict medical supervision.

3. Other Medications: If antihistamines are not effective, your doctor may consider other medications, such as leukotriene receptor antagonists or omalizumab (Xolair), which is an injectable medication used for chronic urticaria.

4. Avoiding Triggers: Identifying and avoiding triggers can significantly help manage symptoms. Common triggers include certain foods, medications, stress, and environmental factors. Keeping a diary of your symptoms and potential triggers can be beneficial.


Management Tips
- Moisturizing: Continue using a good moisturizer to help with skin hydration. This can alleviate dryness and reduce the urge to scratch.

- Cool Compresses: Applying cool compresses to the affected areas can provide temporary relief from itching.

- Avoid Hot Showers: Hot water can exacerbate itching, so opt for lukewarm showers instead.

- Stress Management: Since stress can worsen symptoms, incorporating relaxation techniques such as yoga, meditation, or deep-breathing exercises may help.

- Dietary Considerations: Some individuals find that certain foods can trigger their symptoms. Keeping a food diary may help identify any correlations.


Chronic Urticaria vs. Eczema
Chronic urticaria and eczema (atopic dermatitis) can present with similar symptoms, such as itching and redness, but they are distinct conditions. Eczema is typically characterized by dry, scaly patches of skin that may weep or crust over, while urticaria is marked by transient wheals that can appear and disappear rapidly. Eczema often has a chronic course and can be associated with a personal or family history of allergies or asthma.


Conclusion
Given your ongoing symptoms and the impact on your quality of life, it is essential to maintain open communication with your healthcare provider. If your symptoms persist despite treatment, further evaluation may be necessary to rule out other underlying conditions or to adjust your treatment plan. Regular follow-ups and adherence to prescribed treatments can significantly improve your condition. Remember, managing chronic urticaria often requires a multifaceted approach, including medication, lifestyle adjustments, and trigger avoidance.