Urticaria or Wheal or Skin Hive

 Urticaria: Skin Hives, Itching and Swelling

Dr. KS Prasanna, Director, Institute of Applied Dermatology, Kasaragod, Kerala

After lockdown, on Monday morning, my first OP was a boy with intensely itchy red lesions all over the body with swollen lips. Besides, he had watering of eyes and abdominal pain. The mother was anxious and crying. She said "doctor, my son is having itching all over the body for the past five days. When he scratches, the area becomes red, raised, and hot, and within a half, to one hour it completely goes off. Yesterday night he had abdominal pain and couldn't sleep. Look at his face, we can't recognize his face. Why is it swollen so much like a monkey? I was not able to consult a doctor before, because, by the time he gets ready to consult a doctor, his itching reduces and nothing is visible. So today, early morning, we came to show this to you. I am afraid doctor, is it a serious problem?"

Definitely, it is a common problem, but not a serious problem. Yet some patients end up in the emergency department with breathing problems and anaphylaxis. It is a condition called Urticaria. It is characterized by transient skin or mucosal swellings due to plasma leakage. Superficial dermal bumps are wheals, and deep swelling of skin and mucosa are called Angio-oedema. Wheals are characteristically pruritic and pink or pale in the center. In contrast, Angio-oedema is often painful, less well defined, and shows no color change.

There are several clinical patterns and different causes. There could be an environmental allergy, autoimmunities like Thyroid problem, Drug intakes like pain killers, dietary pseudo allergens, and any kind of infection anywhere in the body like caries tooth. Many cases of spontaneous Urticaria remain unexplained what we call idiopathic, even after extensive evaluation.

Diagnosis is based primarily on history and clinical examination. Determination of the cause, or triggering factor as well as the exclusion of other diagnoses may require detailed investigation, which will be expensive but necessary.

Urticaria is a common disease that may cause considerable distress in the house, even for the professionals. But the symptoms can be reduced by appropriate management. You need to take medicine, which is known as an antihistamine for months and sometimes for years. There are different groups of antihistamines. Your doctor will select an antihistamine, which will take a minimum of 48 hours to give the desired response. If you don't respond then your doctor will change the group of antihistamine. Always keep the tablet, whichever is suitable for you in your purse, and take it at the same time. Also, your doctor will treat, whatever the cause is identified like infection, thyroid problem, etc. Don't get disturbed or get afraid of this itching, but take the treatment appropriate for a long time. Don't be scared of the drug. Antihistamine is a safe drug.