Persistent Hives: Chronic Urticaria and Dermatological Examination
Urticaria (hives) is a condition characterized by red, swollen skin accompanied by severe itching. Specifically, if hives recur almost daily or irregularly for more than 6 weeks, it can be diagnosed as 'chronic urticaria,' which accounts for approximately 30-40% of all urticaria patients. Chronic urticaria can cause significant discomfort in daily life, making it important to identify the exact cause and receive appropriate treatment.
Why Does Chronic Urticaria Occur?
Chronic urticaria can be broadly divided into 'chronic idiopathic urticaria (chronic spontaneous urticaria)' and 'chronic inducible urticaria.' Chronic idiopathic urticaria often has no identifiable specific cause and accounts for approximately 80-90% of all chronic urticaria cases. In contrast, chronic inducible urticaria is triggered by clear eliciting factors such as physical stimuli (pressure, vibration, cold temperature, sunlight, etc.), specific substances (medications, food), or stress.
- Chronic Idiopathic Urticaria (Chronic Spontaneous Urticaria): The cause is often unknown, but it is sometimes presumed to be related to autoimmune reactions, where the immune system attacks the body, causing hives.
- Chronic Inducible Urticaria: Triggered by specific stimuli. For example, cholinergic urticaria occurs with an increase in body temperature, and cold urticaria occurs upon exposure to cold temperatures. Dermatographism appears as swelling in the area when the skin is scratched or pressed.
In addition, hives may appear in association with other underlying conditions such as infections (bacterial, viral, parasitic), thyroid disorders, or rheumatic diseases. Therefore, if hives persist, it is important to consult a specialist to identify the cause.
What Tests Are Performed at a Dermatology Clinic?
To identify the cause of chronic urticaria, dermatologists may perform various tests. Not all tests are applied to every patient; necessary tests are selected based on the patient's symptoms and medical history.
- Medical History Taking and Physical Examination: Detailed questioning about when, how, and in what pattern the hives appear, whether there are triggering factors, and direct examination of skin lesions.
- Blood Tests: Can identify inflammatory markers, thyroid function, and the presence of autoantibodies to assess correlation with underlying diseases. Autoantibody tests may be performed, especially if autoimmune urticaria is suspected.
- Allergy Tests (Skin Prick Test, Blood Specific IgE Test): Confirms allergic reactions to specific foods or environmental factors. However, food allergies are rarely the cause in patients with chronic urticaria.
- Provocation Tests: Performed when chronic inducible urticaria is suspected. For example, if cold urticaria is suspected, an ice cube is applied to the skin to observe the reaction, and for dermatographism, the skin is scratched to observe the reaction.
- Skin Biopsy: Rarely, when differentiation from other skin conditions such as urticarial vasculitis is necessary, a skin biopsy may be performed to examine the tissue under a microscope.
These tests help to identify the cause of urticaria and establish an appropriate treatment direction. However, it is important to understand that in many cases of chronic urticaria, a clear cause cannot be found.
How Is Chronic Urticaria Treated?
The goal of chronic urticaria treatment is to control symptoms, prevent recurrence, and improve the patient's quality of life. Treatment primarily focuses on pharmacotherapy, sometimes accompanied by lifestyle modifications.
- Antihistamines: These are the first-line medications for urticaria treatment. They are effective in relieving itching and wheals, and the dosage can be increased or different types of antihistamines can be combined as needed.
- Corticosteroids: Can be used short-term for very severe symptoms, but caution is required due to the risk of side effects with long-term use.
- Immunosuppressants/Biologics: May be considered for severe chronic urticaria patients who do not respond to conventional treatments. The decision for administration is made based on the specialist's judgment.
- Avoidance of Triggering Factors: For chronic inducible urticaria, it is important to avoid specific stimuli that trigger hives. For example, avoiding cold environments for cold urticaria, and reducing excessive exercise or stress for cholinergic urticaria can be helpful.
Chronic urticaria treatment can be prolonged, and due to significant individual differences, it is important to consult consistently with a specialist to find the treatment method that suits you. Care should be taken not to arbitrarily stop taking medication or adjust dosages.
This article provides general medical information and does not replace individual diagnosis and treatment. If urticaria symptoms persist, it is crucial to consult a dermatologist for an accurate diagnosis and an appropriate treatment plan.
Clinics with Related Procedure Information
- Seoul Dermatology Clinic (Namdong-gu) — Registered Procedures: Allergy/Eczema
Listed in alphabetical order and not a ranking or medical recommendation. Procedure information is based on content registered by each clinic. (Source: Keudeomjip)