Those who are unfortunate enough to contract urticaria/hives/nettle rash know how difficult it is to get information on this problematic life-altering disease. We have been informing you about facts you need to know about this disorder under www.urtikaria.net, giving you tips and answering questions of the patients. The interest is tremendous and new questions and reports on experience gained reach us daily. We therefore revised the most important advice given and information in the form of a manageable guide in 2005. You now have the second, revised and updated edition of this guide in your hands. You will see and find out that it is our particular concern to provide you with practice-oriented and up-to-date information.
The authors of the contributions, all of them urticaria specialists at German University Dermatology Clinics, are aware, thanks to their many years of experience, what is “of burning importance” to urticaria patients: All the important issues are dealt with - from the basics of the underlying disorder to the development of urticaria with its various sub-forms, the frequent triggers and causes of urticaria (and how these can be detected) and the treatment possibilities. You find an exposition of various urticaria diets, addresses of self-help groups and counselling centres, a commented list with relevant literature and a lot of further information in the extensive appendix.
One in four of us suffer from urticaria in the course of our lives. In Germany alone over one million patients are afflicted with the chronic form of urticaria. Good news: In the past years understanding this disease has improved considerably and new possibilities are at disposal to detect and to treat them. This guide explains these innovations and we hope that it will become a helpful companion for many affected persons and their family members.
Berlin and Mainz in September 2014
Marcus Maurer and Petra Staubach
Urticaria (the medical term for hives) involves the sudden appearance of itchy wheals on the skin – on the entire body or just on one part of it, after certain stimuli (e.g. cold or sunlight), or the wheals may appear spontaneously, i.e. without any apparent particular reason (Ill. 1). In addition, many patients develop so-called angioedema, swelling of the skin or of the mucosa. In but a few patients only angioedema develop and no wheals. Nevertheless, this condition is also called urticaria.
Wheals is the term used to describe the skin when it looks as if it has come into contact with stinging nettles. The name urticaria is derived from the nettle (lat. Urtica diocia or urtica urens, the common nettle), the reason surely, when urticarial, the skin looks as if it has been “stung” by stinging nettles (Ill. 3.).
Freshly developed wheals look like small whitish elevations on the skin, surrounded by a red flare. Wheals consist primarily of water released into the skin from the blood vessels. Thereby the smallest skin blood vessels are pressed together and can therefore transport only less blood; the skin then has a “whitish” appearance (Ill. 1a).
We speak of the so-called giant wheals, when the wheals merge and spread over a large portion of the skin (Ill. 1b).
The wheals need not always be whitish and the surrounding skin reddened, sometimes it is exactly the contrary. Particularly if the wheals last longer than a few hours they turn reddish-brown, while the flare around them decreases. The urticaria wheals persist for minutes up to hours, in the case of some patients – rarely – last even longer than one day. They disappear without leaving any visible secondary damage.
Put in simple terms, angioedema is a wheal in the deeper skin layers. While whealing results from fluid escaping from the blood vessels directly under the skin surface, in the case of angioedema the “leak” is deeper. The borders of swellings are therefore less visible and their colour is often not evidently different to that of normal skin. Angioedema frequently occur in the face, affect the hands and feet (Ill. 2).
Due to the particular composition of the skin, the swellings around the eyes and the lips are moderate to severe; however, these symptoms also manifest themselves in the genital area. Angioedema may persist for up to 2 days. Sometimes patients experience pain in the area affected by angioedema. There are other forms of angioedema, too which last longer than two days, the symptoms frequently occur in combination with gastrointestinal disorders or/and recur frequently as familial disposition. In the latter case further clarification should, by all means, be sought.
Beyond the fact that wheals and angioedema can lead to temporary, pronounced disfigurement, particularly in the face, itchiness is the greatest problem for patients with urticaria. Night itchiness can be especially distressful for patients suffering from urticaria; it robs them of their sleep. Itchiness is especially bad for those patients suffering from a special form of urticaria, the so-called symptomatic dermographism (also known as urticaria factitia). Scratching and rubbing the skin stimulates new wheals to develop and a further attack of itchiness – the onset of a vicious circle. The slightest stimulation of the skin, e.g. unconscious rubbing when asleep can give rise to bouts of itchiness. Patients then report they “scratched themselves raw”. It is extremely difficult to ignore pruritus/itchiness! Try for yourself not to scratch when you feel an itch somewhere (e.g. next time you are stung by a mosquito). Recurring itchiness can (as is the case in recurrent pain) become a tremendous burden and as consequence significantly diminish the quality of life.