Urticaria or “hives”, is a common skin condition that causes an itchy rash. The rash can be red or white, and often appears as raised patches or wheals. These bumps can range in size from small dots to large patches and may last anywhere from a few hours to several days. The wheals can occur in clusters and can arise anywhere on the body. The rashes can come and go repeatedly.

There are many different causes of urticaria, including allergies, infections, autoimmune diseases, and insect bites or stings. In some cases, the cause is unknown. Flares can be triggered by heat, exercise, or stress.

Your dermatologist can diagnose urticaria by taking a medical history and physical examination.

Symptoms Of Urticaria (Hives)

Urticaria can present at any age. It is called acute urticaria if it recurs within a period of fewer than six weeks. On the other hand, chronic urticaria lasts longer than six weeks. The symptoms of urticaria can vary significantly from person to person. The main sign is hives – wheals that can be red, itchy, and swollen. Hives can show up anywhere on the body and often appear in clusters.

  • Blanching

    Compared to other types of skin rashes, the center of a red wheal turns white when pressed.

  • Itchiness or “pruritus”

    Oftentimes, the itchiness is very intense.

  • Severe allergic reaction or “anaphylaxis”

    In some cases, urticaria can lead to a severe allergic reaction. When this happens, painful swelling or “angioedema” of the eyelids, lips, tongue, or throat can occur and is accompanied by difficulty of breathing, dizziness, nausea or vomiting, stomach cramps, rapid heartbeat, or a drop in blood pressure.

  • Rash

    Wheals can be red, purple, or skin-colored, depending on your skin color, and can be accompanied by warmth and a burning sensation. The rashes tend to appear and fade repeatedly.

Risk Factors And Causes Of Urticaria

The risk of developing urticaria, either acute or chronic, can increase due to any of the following:

  • Allergies or “atopy”
  • Air pollution
  • Female gender
  • Certain food and medications
  • Occupations with high contact with allergens
  • Positive family history of hives
  • Frequent exposure to insects
  • Infections
  • Comorbidities
  • Existing skin inflammation
  • Stress and anxiety

Persistent Itching And/Or Swollen Skin Rashes?

You may have hives. Consult our MOH-accredited dermatologist with an accurate diagnosis and personalised treatment plan.

Preventing Urticaria Flares

Finding the cause of hives can be difficult because they have numerous causes. However, you can lessen the risk of hive flares by making adjustments to your lifestyle and taking the following measures:

  • Avoid foods that you are allergic to.
  • Look for alternatives to medications that commonly cause allergic reactions (penicillins, aspirin, blood pressure medications, ibuprofen, naproxen, and other NSAIDs)
  • Regular hand washing and maintaining proper hygiene to avoid infections.
  • Get vaccinated against vaccine-preventable illnesses.
  • Restrict your interactions with ill people.
  • Avoid using strong soaps and cleaning products that can irritate your skin.
  • Wear loose-fitting clothes.

Diagnosis of Urticaria (Hives)

During your consultation, your dermatologist may use one or more of the following methods.

  • Medical History

    A detailed history will be gathered from you to help identify any possible trigger. Understanding the reason for your hives may enable you to avoid them, hence preventing future outbreaks.

  • Blood Tests

    Your dermatologist may also request some blood tests to rule out any underlying conditions or infections that could be causing your symptoms.

  • Skin Prick Testing or Patch Testing

    A skin prick test checks your skin’s reaction to various food and airborne allergens. A skin patch test on the other hand concentrates on delayed reactions to contact allergens.

  • Skin Biopsy

    In a skin biopsy, your dermatologist removes a small portion of the affected skin so it can be examined under a microscope.

Dr Noor Hanif Said

Medical Director & Consultant Dermatologist

Over 20 years of experience
in medical, Surgical & aesthetic Dermatology

  • Bachelor of Medicine, Bachelor of Surgery (MBBS, Singapore)
  • Membership of the Royal College of Physicians (MRCP, United Kingdom)
  • Fellow Of The Academy of Medicine, Singapore (FAMS, Dermatology)

Prior to starting his private practice at Mount Elizabeth Novena Specialist Centre, Dr Hanif was a dermatologist at the National Skin Centre and a Visiting Consultant with the Khoo Teck Puat Hospital Dermatology Service.

Apart from his expertise in the management of general dermatological problems such as eczema, psoriasis, hair loss and acne, he has special interests in pigmentary disorders and aesthetic dermatology.

Treatment Of Urticaria (Hives)

The objectives of urticaria treatment include eliminating the itch, eliminating new hives, and avoiding known triggers. Your treatment plan will be created specifically for you and could involve several of the following:

  • Soothing anti-itch lotion or cream

    Lotions containing menthol or zinc oxide can give you temporary relief from the itchiness.

  • Antihistamines

    This type of medication can help control both the itch and swelling.

  • Corticosteroids

    For milder hives, your dermatologist may prescribe a topical corticosteroid to help relieve the itch. An oral medication like prednisone can reduce inflammation and itch in more severe cases.

  • Omalizumab

    When your urticaria is chronic and antihistamines fail to work, this injectable medication may be prescribed to you.

  • Auto-injector

    Commonly known as EpiPen®, this medication is used to treat a life-threatening allergic reaction.

  • Phototherapy

    Also known as light therapy, this non-invasive treatment can be effective when other treatment options don’t work. Several sessions for a few months are needed.

  • Immunomodulators

    If the treatment options mentioned above fail to work, your dermatologist may prescribe another medication called immunomodulators like cyclosporine or hydroxychloroquine. These medications prevent the immune system from overreacting.

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    Frequently Asked Questions

    What can I do when hives appear?
    • Apply a cool compress or wet cloth to the affected areas.
    • Stay in a cool room.
    • Apply an anti-itch cream or lotion or take an antihistamine to relieve the itch.
    • Avoid scratching the rashes.
    • Take a bath in lukewarm water.
    • Use a mild, fragrance-free soap or cleanser when bathing.
    Is urticaria contagious?

    No, urticaria isn’t contagious. However, bacteria, viruses, and parasites can all result in hives hence it is important to rule out if these are the trigger of the hives.

    What food can trigger urticaria?

    Common food triggers for children include milk, eggs, nuts, soy, and wheat. In adults, food triggers are usually fish, shellfish, and nuts. Avoiding these can prevent urticaria flares.