What are the strategies to manage chronic urticaria?

Question

Hi doctor,

For the past seven months, I have been getting these reddish-pink non-itchy bumps on my skin. They are round to oval and small to big. When they first appeared, they were all over my arms, abdomen, back, and on my thighs. Now they randomly show up here and there. I had a large one in my elbow crease and it went away after a day or two. Now, I have two small ones on my forearm, two larger ones on my back, and one on my left lower abdomen. Every time I go to the doctor, and they disappear. Some of them leave flat reddish-like scars for a few weeks. Currently, I am taking Ativan and Metoprolol. But, I was not on these medicines when this rash began. What shall I do now?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I have read your query in detail and viewed the attached pictures (attachment removed to protect patient identity) and do understand your concern. You seem to be suffering from chronic urticaria. It may be due to many things like chemicals, dyes, exertion, insect bite, perfumes, packaged foods, dietary protein allergens, and may be idiopathic. I need to get a few more details about your lesions.

On average, how long does the individual lesion last before settling down?
Any history of swelling on your lips or eyelids during the episodes?
Any history of recurrent fever, joint pains, etc?

Treatment Plan:

1. Usually long-term low dose treatment is required in the form of antihistamines. Example Levocetirizine-Montelukast combination. It consists of Levocetirizine 5 mg and Montelukast 10 mg. This can be taken twice daily in the morning and evening.

2. In severe cases, your doctor may prescribe you a short course of oral corticosteroids.

3. Use a medicated gentle cleansing lotion on your skin for a bath like Cetaphil cleansing lotion.

4. Wear cotton clothes. Avoid allergens like pets, dust, etc.

Preventive Measures:

1. If you find any causative factors such as any dietary substance, dust, exertion, etc., try to avoid it.

2. Apply calamine lotion over affected areas.

I hope this information will help you.

Thanks.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

Occasionally, hives may not be itchy. This may also be the case in angioedema and vasculitic urticaria. Vasculitic urticaria usually persists for days. It may be associated with connective tissue disease. But, I assume there are no typical symptoms like chronically recurrent fever, joint pains, photosensitivity, etc., so the chances are less. Angioedema is usually non-itchy but may be associated with some discomfort or pain. The swelling is at a deeper level, so may persist for a longer duration. It may be associated with bouts of abdominal pain, facial swelling, etc during the episodes. To rule out urticarial vasculitis, a skin biopsy from an individual lesion will be required by your dermatologist at the time the disease is active. Your doctor may carry out investigations to rule out connective tissue diseases like ANA (anti-nuclear antibody), renal function tests, etc. if any suspicious signs and symptoms occur in the future. Revert with the investigation reports to a dermatologist online.

I hope this information will help you.

Thanks.