Skin irritation and persistent hives: Underlying reasons and remedies
Chronic hives, also known as chronic spontaneous urticaria (CSU), can be a persistent and bothersome condition, causing itchy skin and raised, pink or red bumps on the skin. The immune system plays a significant role in the mechanism behind chronic hives, and it may be an autoimmune response or a response to specific triggers.
Common Causes and Triggers
Chronic hives can stem from a variety of factors, often with unclear origins (idiopathic), but several are frequently identified.
Physical Triggers
Physical stimuli such as pressure on the skin (e.g., tight clothing), cold exposure (cold air, water), heat or warmth (hot showers, exercise), sunlight (solar urticaria), and even vibration or sweating can induce hives. These are classified as physical or inducible urticarias, with distinct subtypes based on the triggering stimulus.
Allergic Triggers
Although true allergic causes for chronic hives are less common than acute cases, certain food allergies (e.g., to meat in α-gal allergy, fish parasites), medications (antibiotics like penicillin, blood pressure drugs such as ACE inhibitors), insect stings, and rarely environmental allergens can contribute.
Infections and Illness
Viral infections (e.g., upper respiratory infections, viral hepatitis), bacterial infections (like Helicobacter pylori), and sometimes fungal or parasitic infections can activate mast cells and trigger chronic hives.
Autoimmune Factors
Many chronic spontaneous hives are believed to be autoimmune in nature, sometimes associated with autoimmune thyroid disease, rheumatoid arthritis, or lupus, often accompanied by other systemic symptoms.
Stress
Psychological stress can exacerbate or trigger hives via neuroimmune pathways impacting skin inflammation.
Diagnosis and Treatment
To diagnose chronic hives, doctors perform a physical examination of the skin and ask questions to determine the cause or trigger. Treatment for chronic hives includes wearing loose-fitting clothes, using products on the skin that contain no irritants or common allergens, applying cold compresses, using over-the-counter anti-itch creams such as calamine lotion or antihistamine creams, practicing relaxation or mindfulness techniques, and managing stress.
Identifying personal triggers is essential for management, and antihistamines are a common treatment. If doctors identify the cause of chronic hives, they may provide a person with more tailored treatment, including antihistamine medications, omalizumab (Xolair), cyclosporin, or corticosteroids.
Living with Chronic Hives
Chronic hives can reappear later on, but treatment can help manage them. Anyone who is concerned about recurring itchy skin and hives should speak with a doctor or dermatologist. It's essential to remember that chronic hives is a distinct medical condition, and infections from specific bacteria, viruses, and parasites are also associated with chronic hives.
Some people with chronic hives may have a higher rate of vitamin D deficiency and dysbiosis. Other autoimmune diseases with links to chronic hives include rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, celiac disease, type 1 diabetes mellitus, Hashimoto's thyroiditis, pernicious anemia, Graves' disease, vitiligo, polyglandular syndrome with autoimmune thyroid disease, pernicious anemia, or vitiligo, and mixed connective tissue disease.
Prognosis
About 50% of people recover from chronic hives within 1 year, and between 80-90% experience a reduction in symptoms within 5 years. Autoimmunity may be a cause of CSU, and many people with CSU also have another autoimmune condition. The most common autoimmune condition in people with CSU is hypothyroidism.
In conclusion, the etiology of chronic hives is often idiopathic or autoimmune, with physical stimuli, infections, allergies, medications, and stress as notable triggers. Understanding these causes and triggers can help individuals manage their condition and seek appropriate treatment.
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