Urticaria is a skin condition that causes an itchy rash or hives. Symptoms lasting less than six weeks are diagnosed as acute urticaria while anything persisting longer than six weeks is categorised as chronic.
Symptoms of Chronic Urticaria
The main symptom of chronic urticaria is small weals that develop on the skin and can affect any area of the body. These weals are usually circular, raised areas, red or white in colour often surrounded by a red flare and are very itchy.
Each weal usually lasts less than 24 hours and fades before the surrounding flare does, making the skin look red and blotchy until eventually the blotches also disappear.
In some cases the weals spread into each other, causing large welts and swelling, normally around the eyes and lips, the hands and feet, genitalia and inside the throat, which can restrict breathing if its left untreated. This is known as angioedema and affects 40% of all chronic urticaria sufferers.
Another condition brought on by chronic urticaria is vasculitic urticaria. This is where the weals last longer then 24 hours, are often very painful, become dark red in colour and may leave a red, pigmented mark on the skin once they have faded.
Causes of Chronic Urticaria
Chronic urticaria attacks are not always allergic reactions. In fact, most are not.
Almost half of all cases are due to an autoimmune disorder where the body makes antibodies against itself. It releases histamine which causes blood plasma to leak out of small blood vessels in the skin and pool to form the weal. The trigger is not known or identified in many cases. The remaining 50% of sufferers are often diagnosed as having chronic idiopathic urticaria (CIU) which simply means that the cause is not known.
Other possible causes of chronic urticaria include allergies to food, medicines and parasites such as worms in the gut. Although this is common in acute urticaria it is not so common with chronic urticaria.
Physical urticaria occurs when the rash appears when the skin has been physically stimulated. Examples of this are:
- dermographism, which literally means "skin writing." The rash develops on areas of the skin that have had direct pressure from being physically stroked. So if the sufferer was to pretend to write their name on their skin with their finger, the rash would apper directly where the finger had run. Areas that are less commonly affected include the palms of the hands, the soles of the feet, genital skin and the scalp. The rash with this type of urticaria generally lasts less than an hour although sufferers are more prone to heat rashes.
- cholinergic urticaria. This type is caused by sweating and is someimes called heat bumps. The weals are small, only two to three millimetres in size but still with a red flare around each one. The rash only lasts 30 to 60 minutes and is generally worse on the chest, the back and the arms.
- cold urticaria develops after the skin is exposed to cold conditions including cold winds and cold water and only the chilled parts of the skin are affected. This type of urticaria is uncommon.
Another uncommon form of urticaria is delayed pressure urticaria. This is when the rash can develop four to six hours after prolonged pressure has been applied to the affected area. This can be anything from tight belts around the waist to elasticated socks or even standing for a long period of time. Delayed pressure urticaria is very painful and can last for several hours.
Solar urticaria is very rare and develops after the skin has been exposed to direct sunlight.
Lastly, another rare form of urticaria is aquagenic urticaria which affects skin that has been exposed to water of any temperature.
A germ called H Pylori, which is found in the stomach, may also be a factor in some cases. This can be diagnosed using a simple blood test and, if positive, the infection can be treated with antibiotics.
Treatment of Chronic Urticaria
There are a few treatments for chronic urticaria but the main one is antihistamine tablets. These block the action of the histamine and can offer some relief to the sufferer.
Another treatment is avoidance of anything that appears to trigger the urticaria flare ups. This can mean avoiding tight clothes, trying to keep cool, avoiding alcohol, hot baths, strong sunlight and any undue stress or emotion or staying away from some medicines like anti-inflammatory painkillers such as ibuprofen, codeine or ACE inhibitors.
A short course of steroid tablets may be used for particularly bad attacks of urticaria although use of these has to be kept to a minimum due to the serious side effects the steroids can cause.
Also some asthma treatments can be used to counteract the affects of urticaria although this should always be recommended by a doctor.
Prognosis for Chronic Urticaria Sufferers
For some sufferers, symptoms may go away completely after just a few months while for approximately 50% of cases the symptoms ease within three to five years. However, about one in five cases lasts on and off for more than 10 years.
This is a baffling disorder that causes pain, discomfort and embarrassment to its sufferers, many of whom struggle to maintain a full and active life.
The International Chronic Urticaria Society provides online information and support for sufferers and encourages us to unite in support of chronic urticaria sufferers by wearing a polka dot ribbon.
Sources:
www.patient.co.uk
The International Chronic Urticaria Society
BBC Health: Urticaria
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