Urticaria (Hives)

Urticaria is a common skin condition characterized by sudden-onset, often itchy, pale-centered, red-edged raised lesions (wheals). It is also known in the public as “kurdeşen.” Lesions typically resolve spontaneously within a few hours but may recur over days or weeks. Urticaria can present as either acute or chronic forms. Although often considered an allergic mechanism, the underlying cause cannot be identified in many cases.

Classification

Urticaria is classified according to duration and cause. It has two primary forms: acute urticaria and chronic urticaria.

Acute Urticaria

Characterized by lesions lasting less than six weeks. Most cases fall into this category. It is commonly associated with exposure to allergens infections medications or foods. It develops rapidly and usually resolves with treatment targeting the underlying trigger.

Chronic Urticaria

A form characterized by recurrent urticarial lesions lasting more than six weeks. It is divided into two types: chronic spontaneous urticaria and chronic inducible (triggered) urticaria. An underlying cause is often not identified. Autoimmune mechanisms may play a role.

Chronic Spontaneous Urticaria

Characterized by recurrent lesions arising without a known trigger. It can significantly impair patients’ quality of life.

Chronic Inducible Urticaria

A form of urticaria triggered by physical or environmental stimuli. It may manifest in response to cold heat sunlight pressure water or exercise. Examples include cold urticaria dermographism and cholinergic urticaria.

Clinical Features

The lesions known as wheals:

• Develop suddenly.
• Are itchy.
• Consist of pale-centered raised areas with red borders.
• Typically resolve within a few hours without leaving traces.
• New lesions may recur in different areas of the body.

Itching is the most prominent symptom and may be accompanied by a burning sensation in some cases.

Association with Angioedema

Angioedema occurs in approximately 40 percent of urticaria cases. Angioedema is an acute swelling of the deep dermis and subcutaneous tissue. It commonly affects the eyelids lips tongue genital area and extremities. It may be painful. Angioedema involving the airway requires emergency intervention.

Causes

The underlying causes of urticaria are diverse and a specific trigger cannot be identified in a significant proportion of cases.

Common Causes

• Infections: Viral upper respiratory tract infections
• Medications: Antibiotics (particularly penicillin) NSAIDs aspirin
• Foods: Shellfish nuts strawberries eggs
• Insect bites
• Physical factors: Heat cold pressure sunlight
• Stress
• Autoimmune diseases: May be associated with thyroid disorders

Diagnosis

Diagnosis is typically based on clinical history and physical examination. Further investigations are generally unnecessary in acute cases. In chronic cases allergy tests autoimmune panels complete blood counts and infection screenings may be performed.

Differential diagnosis should consider:

• Erythema multiforme
• Vasculitis
• Contact dermatitis
• Atopic dermatitis

Treatment

Treatment is planned according to the severity and duration of the disease. The most important principle is avoidance of the triggering factor if identifiable.

Lifestyle and Supportive Measures

• Avoid hot baths
• Reduce stress
• Avoid tight clothing
• Use moisturizers

Monitoring

In patients with chronic urticaria who do not respond to treatment referral to specialized centers may be necessary. During clinical follow-up the severity duration and response to treatment should be assessed.

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