5 Skin Interactions That Can Trigger Chronic Hives
You’ve tossed your favorite perfumes, switched to fragrance-free detergents, and cut out everything from latex to food dye. And yet, it’s still not enough to prevent the continual flare-ups of red, itchy welts that break out on your skin.If this sounds familiar, you could be dealing with chronic spontaneous urticaria (CSU), a condition where hives occur nearly every day for six weeks or longer. Unlike acute hives, which are often tied to a specific product or irritant, CSU can have less obvious triggers. Experts aren’t entirely sure what causes it, but they suspect it stems from an immune-system response that mistakenly releases histamine in reaction to a perceived threat, such as an allergen or infection. That release of histamine can lead to the swelling and itchy welts associated with hives.Complicating matters, a flare-up of CSU may not occur until days, weeks, or even months after being exposed to the trigger. “Sometimes there’s a delay to the reaction, so people think if they were exposed to something a while ago, it couldn’t be related to the rash they currently have,” says Marisa Garshick, MD, a board-certified dermatologist at Medical Dermatology & Cosmetic Surgery Centers in New York City.Even if the exact cause of CSU isn’t always clear, certain exposures and skin interactions are known to trigger flare-ups. Here are some of the most common culprits, plus what you can do to keep your symptoms at bay.1. Shaving Or Scratching Your SkinEven light scratches—like those from shaving your legs—can cause a CSU flare-up. Sometimes, the welts can appear as raised, inflamed lines called dermatographia, while other times they show up as hives, Dr. Garshick says. If you tend to feel itchy after you shave, “try to avoid scratching the skin and use an anti-itch lotion, which can calm down the skin,” she says.What May Help: If you’re currently having a flare, taking an antihistamine about 30 minutes before you shave can help quell some of the inflammation. Dr. Garshick also recommends using a moisturizing lotion or shaving cream (rather than just water) to minimize the friction of the razor blade on the skin.2. Friction From ClothingA bra that digs into your back. A too-tight waistband on your jeans. A purse strap on your shoulder. Irritation from clothing and accessories can cause hives—usually “only in the area of the friction,” but sometimes all over the skin, Dr. Garshick says. “People who are really bothered by it, or when the reaction is substantial, should also avoid other tight-fitting clothes or [material like] spandex,” she says, since this can also cause a flare-up.You’re not doomed to flare-ups every time you carry a purse on your shoulder, but you may be more vulnerable at certain times than others. “Sometimes people go through phrases where [their CSU] is more intense than not,” Dr. Garshick explains. “It doesn’t mean you’ll have the issue every single time. It kind of waxes and wanes.”What May Help: Choosing looser-fitting clothes and avoiding straps, waistbands, or other materials that repeatedly rub against the skin may help reduce symptoms.3. Exposure To Cold In rare cases, hives can appear after exposure to cold air, water, or objects (like ice cubes). Called cold urticaria, this subtype of hives affects only about 0.05 percent of people. The main symptom is a rash that appears after the exposure is over and the skin temperature starts to rise again. Typically, it goes away within an hour or two, but sometimes it can last for multiple days.What May Help: It’s not known why some people develop the condition, but if you want to prevent a flare-up, your best bet is to avoid all forms of cold water: cold plunges, showers, and swimming pools. Likewise, try to avoid going outside during frigid temperatures (or bundle up with warm clothing) and forgo ice-cold beverages and frozen foods like ice cream.4. Heat And SweatLike cold exposure, coming into contact with something hot can also cause a CSU flare. Known as heat-induced or cholinergic urticaria, this type of hives is triggered by an increase in body temperature. “Heat often causes the blood vessels to expand, and that can aggravate redness and potentially make flushing worse, so histamine can follow as part of that,” Dr. Garshick says.What May Help: Sweating can also trigger heat-induced urticaria, so wearing loose, breathable clothing when you exercise may help reduce irritation, says Megan Rogge, MD, an associate professor and board-certified dermatologist at UTHealth Houston. The good news: Symptoms are typically short-lived, often subsiding within 1 to 3 hours.5. Contaminated Food Or WaterOne often-overlooked cause of CSU is Helicobacter pylori (H. pylori), a type of bacteria that can cause stomach pain and other uncomfortable GI symptoms like gas and nausea. This bug is more common in areas lacking clean water, but it can also be present on contaminated surfaces as well as in food and water. An H. pylori infection may trigger the release of histamine in the skin and make the stomach lining more susceptible to allergens, according to one published study. Other infections and illnesses can trigger a CSU flare-up as well, in part because the immune system goes on high alert, Dr. Garshick says.What May Help: If your doctor suspects an H. pylori infection, they can screen for it with a stool or breath test. Medication, including antibiotics, can be used to treat the underlying infection, which can help clear up the hives, Dr. Rogge says.How To Treat CSUIf you’ve been experiencing hives for weeks, it’s time to see a specialist. After all, “you can only avoid triggers for so long,” Dr. Rogge says. If your hives seem to be related to allergies (think: they often crop up after you’re exposed to pollen or pet dander), she recommends consulting an allergist. If allergens don’t appear to be driving your flares, a dermatologist can help evaluate other possible causes.Your doctor will probably start by recommending a short-acting, over-the-counter antihistamine, which could quell the itching and swelling right away, Dr. Rogge says. Talk to your doctor about dosing—specifically, the possibility of taking an extra dose if you know you’re going to be exposed to something that might trigger a flare. “After about a month, I tell my patients they can try coming off it, and if they start experiencing hives again, they need to be back on it,” Dr. Rogge says.“We have good options for people [with CSU]. I haven’t met a patient I couldn’t help with one of the medications.”If over-the-counter meds aren’t helping your symptoms, your doctor may add a longer-acting prescription medication to your treatment regimen.A reassuring note: You probably won’t need to stay on medication for the rest of your life. Research shows that CSU usually lasts about 2 to 5 years on average, with up to 50 percent of people experiencing spontaneous remission after one year. Until then, the condition is highly treatable.“We have good options for people [with CSU],” Dr. Rogge says. “I haven’t met a patient I couldn’t help with one of the medications.”Maria Masters is a contributing editor and writer for Everyday Health and What to Expect, and has held positions at Men's Health and Family Circle.
