Why do itchy, bite-like marks suddenly appear on my face?

Question

Hello doctor,

I am so frustrated with what is happening to my face. At random times, it suddenly becomes itchy even though there has been no contact with anything. Then it appears like a bite mark, even though, as mentioned, there was no contact at all. These marks may go away within a few hours or last for many days, depending on the situation.

Yesterday, while I was outside, I forgot to bring an umbrella and a fan. When I returned home and took a bath, my face became itchy and painful. I can notice some bite-like marks, but they are not always very clear and are sometimes barely noticeable.

I have been suffering from this for years and would like to understand why this keeps happening.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am really sorry that this has been going on for such a long time. Understandably, this feels frustrating and distressing, especially when the symptoms occur without warning.

Based on the history provided, known triggers, and the attached image, the symptoms are most consistent with cholinergic urticaria (a type of physical urticaria). This condition is triggered by a rise in body temperature. It commonly occurs with heat exposure, sweating, hot showers, exercise, emotional stress, or sudden temperature changes.

The itching and burning sensation, followed by small bite-like bumps, occur because heat and sweating stimulate the release of histamine from mast cells in the skin, even without any insect bite or direct contact. This explains why the lesions can appear suddenly, may be subtle or barely visible at times, and may resolve within a few hours or sometimes last longer.

For management, I would suggest the following measures:

The mainstay of treatment is non-sedating antihistamines.
Treatment can be started with Fexofenadine 120 milligrams once daily at night for three weeks. If symptoms are frequent or severe, the dose may be increased to twice daily under medical supervision.
Taking the antihistamine regularly, especially during hot weather or before known triggers, is more effective than taking it only when symptoms appear, as it helps calm the immune response.
If the burning or itching is intense, Calamine lotion can be applied. A cooling, fragrance-free moisturizer such as physiogel moisturizer may also be used to soothe the skin.
Hot showers should be avoided. Lukewarm water is preferred, and the skin should be gently patted dry rather than rubbed.
Keeping the environment cool, wearing loose and breathable cotton clothing, avoiding excessive sun exposure, and taking breaks to cool down when sweating begins can be helpful. Carrying a small fan or a cooling towel may also provide relief.

It is important to note that this condition is not dangerous, not contagious, and not related to poor hygiene or insect bites. Many individuals experience this condition for several years. The good news is that it often improves with age and can be well controlled with proper treatment and trigger avoidance.

If symptoms remain uncontrolled despite daily antihistamine use, higher doses or additional treatment options may be required under medical guidance. Continue the prescribed medication for three weeks and follow up if symptoms persist.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.