Hives (urticaria): symptoms, causes, therapy

Wheals form on the skin that are very itchy? This symptom can indicate the disease urticaria (urticaria, hives)

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Briefly explained: what is hives?

Definition: Urticaria (urticaria, hives) is a common skin disease. It is not contagious.

Symptoms: Fluid-filled swellings, so-called wheals, form on the surface of the skin. They itch and burn, similar to when they come into contact with nettles (urtica = Latin for "nettle"). Sometimes there is also deep swelling called angioedema.

Causes: For most of those affected, the skin changes occur in bursts and independent of external influences. Then one speaks of a spontaneous urticaria. The wheal relapses in the context of spontaneous urticaria can be favored by infections or, less often, by intolerances. Inducible urticaria, on the other hand, occurs when the wheals are triggered by a certain external stimulus, such as physical stimuli such as heat, cold or pressure.

Therapy: Depending on the cause, urticaria can be treated with certain drugs - antihistamines, for example. Sometimes it is also important to avoid the triggering stimulus.

What are the symptoms of urticaria?

The typical symptoms of urticaria are wheals that itch and burn severely. Sometimes deeper swellings (angioedema) occur at the same time.

What are wheals?

A wheal is a circumscribed accumulation of water in the superficial parts of the skin (see picture gallery below). The wheal protrudes sharply on the surface of the skin and can be surrounded by an inflammatory reddening. The color of the wheal varies between skin-colored and whitish. The individual skin changes can measure a few millimeters, but can also be up to two centimeters in size. Neighboring wheals can flow together to form extensive swellings.

Even without therapy, the individual wheals recede completely within 24 hours. At the same time, however, new wheals can develop in other places. In the most common form of the disease, spontaneous urticaria, the wheals are distributed irregularly over the entire skin.

What is angioedema?

Angioedema occurs in some patients at the same time, while only a few suffer from angioedema (see picture gallery below). These are characterized by large, indistinct, deep swellings that recede spontaneously over the course of one to three days. There is usually no redness or itching. Instead, those affected suffer from a feeling of tension and occasionally from a painful burning sensation.

Angioedema occurs preferentially on the palms and soles of the feet as well as on the face. In the area of ​​the eyelids and lips, the subcutaneous tissue is very soft. Therefore, a swelling can take on particularly large dimensions and temporarily disfigure the person affected. If the mucous membranes of the tongue, throat, or larynx are affected, breathing may be difficult.

In many cases, isolated angioedema is a side effect of a drug from the group of ACE inhibitors (ACE inhibitor-induced angioedema). Angioedema is very rarely a sign of an inherited disease: hereditary angioedema.Especially in the area of ​​the mucous membranes, angioedema is also known as Quincke's edema after the first person to describe it, the doctor Heinrich Irenaeus Quincke.

This is what hives (urticaria) can look like

© Your Photo Today / A1Pix


© Your Photo Today / A1Pix

The typical symptoms of hives (urticaria) are wheals - very itchy swelling of the skin

© SPL / Dr. P. Marazzi

Wheals can - depending on the type of hives (urticaria) - spread over the skin

© SPL / Phil Degginger

Hives (urticaria): Neighboring wheals can flow together to form extensive swellings.

© SPL / Dr. P. Marazzi

Special form Urticaria factitia: The shape of the wheals is given here from the outside. Shear forces on the skin, for example from scratching, lead in this example to line-shaped wheals


Heavily swollen eyelid in angioedema. In the area of ​​the eyelids and lips, the subcutaneous tissue is very soft. Therefore, swelling here can be large

© ddp Images / HAE Vereinigung e.V

In angioedema, the lips can also swell significantly


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What types of hives are there?

Spontaneous urticaria

In spontaneous urticaria, the wheals are irregularly distributed over the entire skin. In over 90 percent of cases, the disease heals within six weeks. Then there is acute spontaneous urticaria, which is also called acute urticaria for short. It is by far the most common form of hives.

If the wheal formation lasts longer than six weeks, one speaks of chronic spontaneous urticaria or, for short, of chronic hives. This mostly affects middle-aged people, women about twice as often as men.

Acute spontaneous urticaria is often triggered by an acute infection. In some cases, the skin changes are caused by an immediate allergic reaction (anaphylactic reaction), such as a wasp or bee sting, food or medicine.

A specific cause can also be determined in around 80 percent of patients with chronic spontaneous urticaria. Most often this is a chronic infection (infectious urticaria), an intolerance to a drug or food ingredient that has been taken repeatedly (intolerance urticaria) or a persistent reaction of the immune system to the body's own structures (autoreactive urticaria).

In around 20 percent of those affected, the cause cannot be clarified. Then one speaks of idiopathic urticaria.

Inducible urticaria

In the case of inducible urticaria, wheals only occur when a specific stimulus acts on the skin. If this stimulus represents a physical quantity, such as pressure, cold, heat or light, then it is a physical urticaria. In contrast to spontaneous urticaria, the skin changes only occur in the areas on which the specific stimulus acts.

Important: Itchy redness and swelling on the skin can have numerous causes. It is not always urticaria. Therefore, always have changes to the skin clarified by a doctor!

Author and Expert: Dr. Angela Unholzer, specialist in dermatology

© W & B / private

Therapy of urticaria

The doctor internally treats both the acute and the chronic form of spontaneous urticaria with drugs that block the effects of the messenger substance histamine. These active ingredients are called antihistamines.

With the inducible forms of urticaria, it is advisable to avoid the trigger. If this is not completely successful, the person affected can also suppress the symptoms with the help of an antihistamine.

You can read more about treatment in the Therapy chapter.

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. It cannot replace medical advice. Please understand that we do not answer individual questions.

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