What causes chronic skin allergy with red welts?

Hello,

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Having gone through the history provided and the reports attached (attachments have been removed to protect the identity of the patient), it appears to me as urticaria. Urticaria is basically a hypersensitivity reaction of the skin to any external allergens.

They may not be from physical allergens per se, but they may also be changes in the body temperature, lesions due to sun exposure, lesions following a bath, exposure to cold, due to stress, due to an extremely hot climate, and due to food items as well, and also following an insect bite.

They may also be formed following the intake of any medications for any medical conditions. Urticaria is an internal response of the body to any external stimuli, which may or may not be seen by the naked eye. Unfortunately, it does not have a cure, as it is an intrinsic response from within the body. They may be present since birth or may develop later in life. They may be present for a few years and, for some individuals, may eventually fade away. Fortunately, they may be managed each time they develop, and recurrences may be prevented.

For this purpose, the first and foremost advice would be to note down in case of any responses following exposure to any particular changes within the body, including stress, sun exposure, following a bath, and following intake of any medications. They usually appear as hives, which may be red or skin-colored lesions that may be slightly raised. They may present with itching, irritation, redness, and a burning sensation, which varies from individual to individual and may also subside within a few hours or days without any treatment.

For some individuals, they may also show dermographism, in which when a blunt object is used to strike in a linear manner on the forearm, they may respond by forming a raised linear lesion on the area, which may last for hours as compared to an individual without an allergic reaction.

My advice :

1. As you have mentioned, regarding the intake of the Fexofenadine tablet, I would like to advise you to continue the same, but with the addition of Montelukast, to be taken at night orally at dinner and one hour before going to bed. They may be continuously used for one week or whenever there are lesions for faster recovery. These are antihistamines that help in reducing the symptoms as well as inflammation associated with the rashes.
2. Hydrocortisone 1% cream may also be used on the areas where rashes appear. They may be used in the smallest quantity possible in a very thin layer, which helps in faster recovery and reducing the itching. Although this cream is not mandatory, it may help in the faster reduction of symptoms. They may also be used whenever there are lesions. However, once started, they can be used for a maximum period of one week.
3. In case of rashes following sun exposure, physical protection in the form of caps, sunglasses, outfits preventing exposure, and sunscreens may be used to prevent rashes.
4. Stress management and making sure to avoid any food item that possibly might be an allergy may be considered.
5. Make sure to take baths in normal-temperature water rather than extremely hot and extremely cold water.
6. In case of rashes following cold exposure, it is advised to keep yourself warm and protect it with layers and woolen clothes.

As I have mentioned earlier, urticaria does not have a definite treatment or cure due to it being an internal reaction to external stimuli. Therefore, consistency with the medication is key whenever there are rashes that appear. However, this is not a life-threatening condition.

I hope the details provided above were informative and provided clarity.

Thank you.