What treatment is recommended for recurring hives on thighs?

Question

Hi doctor,

I have had hives for a month. They are recurring in my feet, left leg, underarms and face. The rash is in one or more of those places every day. My left thigh has remained inflamed and covered with hives. I have kept a photo diary. I have seen a local dermatologist who did a punch biopsy. I will attach the report here for your reference. What follow-up would you recommend? Is that due to any allergy? I have a consultation in a few weeks with a different doctor. What questions should I ask? What are rare eosinophils? What is your overall impression of the findings? Is there anything that I should concern? Can you explain the histologic findings? I do want you to know that the report has an error. The punch biopsy was taken from my left hip. My abdomen has been completely free of any hives. They also did laboratory work, which was unremarkable. Also, I have a branch duct IPMN. I am 5'6" tall and weight is approximately 150 lbs. I do not smoke or take any medications. Except for the rash, 50 mg Zyrtec three times a day and 75 mg Hydroxyzine at night. I have not changed anything in my environment. Further, I travel extensively for my job and they appear regardless of where I am.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Your history, clinical description and histopathology (attachment removed to protect patient identity) are most likely suggestive of urticaria. Urticaria is an immediate hypersensitivity reaction of the skin to various common triggers such as insect bites, infective focus elsewhere in the body, changes in the environment, certain painkillers, some foods such as seafood, peanuts, and mushrooms, thyroid disorders, etc. Although immediate, the effect of each episode tends to last up to four weeks; wherein there will be a delayed release of inflammatory mediators, putting you at further risk for a new episode. I would advise you to try and find out the possible triggering factor for the attacks, which usually lies in the activities and exposures of the previous one hour before the episode. You could ask your doctor to help you to find out the risk factors regarding your term of medication. You could also take note of the emergency measures needed in case you tend to have a severe episode with swelling of lips and face. Rare eosinophils in your biopsy suggest that there are only a few occasional allergic white blood cells in the field. The overall impression is that you are having an episode of urticaria, which very well responds to antihistamines such as Cetirizine and Fexofenadine. However, they need to be taken for a duration of two to four weeks at least. It is a very common skin problem and can be managed comprehensively. Your biopsy confirms the same too.

I hope this information will help you.

Thanks.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

The lesion on your thigh looks entirely different (attachment removed to protect patient identity). In urticaria, the lesions are only transient and last less than 24 hours. It is in total contradiction to what you have mentioned. However, it still looks benign and mostly eczematous in appearance. The spongiosis found in your biopsy could be a point for an eczema; however, it can even be found in early lesions of urticaria. The other close differential would be tinea which is a fungal infection. I would advise you to try a course of topical 2% Miconazole cream for a week and re-assess the response before going for topical steroids.

I hope this information will help you.

Thanks.