Urticaria (Hives)

Urticaria, known widely as pitti, is a condition in which raised, itchy swellings appear suddenly on the skin. These swellings, called wheals or hives, may be pink or skin-coloured with a red flare around them, and they can be as small as a mosquito bite or as large as a palm. The most typical feature is that any single wheal comes up and settles within a few hours to a day, leaving normal skin behind, while fresh ones appear somewhere else. Sometimes there is deeper puffy swelling of the eyelids, lips, hands or feet, called angioedema, which burns or feels tight rather than itching.

Urticaria is common and can affect anyone at any age. When episodes settle within six weeks it is called acute urticaria and is often linked to an infection or a medicine. When wheals keep appearing on most days for more than six weeks, it is called chronic urticaria, and in a large number of these cases no external trigger is ever found, because the immune system is releasing histamine in the skin on its own. This is the part patients find hardest to accept. Many people spend months eliminating one food after another, get expensive allergy panels done, or take repeated steroid injections from unqualified providers for quick relief. Others simply take a tablet whenever it flares and stop the same day. Chronic urticaria is not dangerous for most people, but it disturbs sleep, work and mood, and it responds far better to regular, supervised treatment than to guesswork.

Diagnosis & Treatment

Diagnosis of urticaria is mainly clinical and depends heavily on the history. A dermatologist will ask how long each individual wheal lasts, whether it leaves any mark behind, whether there is deeper swelling of the lips or eyelids, what medicines and painkillers have been taken, whether flares follow heat, pressure or exercise, and whether there are any other symptoms such as fever, joint pain or weight loss. Photographs taken on your phone during a flare are genuinely useful, because the skin is often clear by the time you reach the clinic. Testing is usually kept limited and targeted, such as basic blood tests or thyroid tests where indicated, and treatment for an infection if one is found. Broad allergy panels ordered without a matching history often produce results that are misleading rather than helpful, and can lead to unnecessary food restriction. If wheals last longer than a day, hurt or burn rather than itch, or leave a bruise or stain, further evaluation including a skin biopsy may be considered, since that pattern suggests a different diagnosis.

The mainstay of treatment is a regular, non-drowsy antihistamine taken daily as a course rather than only on the days the skin flares. If symptoms are not controlled, the dose may be increased in steps under medical supervision, which is standard practice in international guidelines but should never be done on your own. For patients who continue to flare despite this, dermatologists use additional categories of treatment, including immune-modulating tablets and biologic injectable therapy for difficult chronic urticaria, always with appropriate monitoring and follow-up. Oral steroids have a limited role in short courses for a severe flare or significant swelling. They are not a long-term solution, and repeated steroid courses or injections cause weight gain, raised blood sugar, bone loss and other serious problems, which is why relying on them is strongly discouraged.

What should you expect? Acute urticaria triggered by an infection or medicine often settles within days to a few weeks. Chronic urticaria behaves differently: it tends to run a course over months or a few years, with good and bad phases, and in many patients it eventually settles on its own, although no one can predict the exact timeline for an individual. The goal of treatment is complete control of symptoms so that you sleep and function normally, after which medication is tapered slowly under guidance rather than stopped abruptly. The common mistakes to avoid are taking a tablet only on bad days, stopping treatment the day the skin looks clear, cutting out large groups of foods without evidence, taking painkillers that trigger your flares, and accepting repeated steroid injections for instant relief. Simple measures help alongside medicines: keep the skin cool, avoid very hot baths and tight clothing during a flare, use plain moisturiser, and keep a short diary of flares and medicines to bring to your follow-up visit.