George Woodbury MD 3/8/2023
Urticaria is a term used by Dermatologists for a skin event that occurs when a chemical called histamine is released by a certain immune cell within the skin – called the Mast Cells. This release is often triggered by some factor – be it what’s called a “physical factor,” like exercise or heat or even scratching of the skin – or an allergic factor – such as a drug or medication to which that a person has become allergic. The result is whelps or swellings that develop in the skin, which can be on a localized part of the body or the entire body, sometimes a soon as seconds after that trigger factor arises.
What does the term Urticaria refer to?
This skin reaction of Urticaria or Hives refers to a whelp like eruption originally observed when people came in contact with a plant – called the Nettle or Stinging Nettle – which occurs in both Europe and North America. This plant – of the plant family Urticaceae - when coming into contact with the skin – produces immediate stinging whelps – when it comes in contact with the skin – generally of the lower legs when walking in a field – so this is a type of “Contact Urticaria” – because the reaction occurs immediately in just about anyone who comes in contact with the stinging nettles or hairs of this plant – generally people walking in a field with this herbaceous plant in it.
Can Urticaria be similar to other types of Skin Rashes?
Certain common skin rashes – like Psoriasis or Atopic Dermatitis (Eczema) - can have a similar appearance to Urticaria – so sometimes it takes a Dermatologist like myself to distinguish which type of reaction is going on in the skin.
What are most common trigger factors for Uticaria or Hives?
High on the list are certain medications and drugs – including Aspirin, just about any Nonsteroidal Drug (NSAIDs), Codeine, or certain foods, particularly Chocolate, Shellfish, Nuts, and certain preservatives, spices, and fragrances in foods. But many different types of medications have been reported as triggering hives. Certain connective tissue conditions – like Lupus and Dermatomyositis – can also trigger Hives – sometimes requiring bloodwork and urine testing for further evaluation.
What type of testing can help patients with Urticaria or Hives?
Dermatologists such as myself generally consider one of about three types of tests to evaluate Hives. First, we sometimes do a skin biopsy or skin excision to look for whether a given case is actually Hives or rather a type of Contact Dermatitis, or whether it may be another type of skin condition, such as Dermatitis Herpetiformis (which is due to a sensitivity to wheat gluten), or even possibly an autoimmune condition such as Lupus. There is also a special type of Hives called Angioedema which can be genetic – meaning it runs in certain families. There is also an autoimmune type of Hives called Urticarial Vasculitis which sometimes involves internal organs like the kidneys, and sometimes requires systemic steroids to bring it under control. So sometimes this type of skin biopsy is helpful in sorting out the underlying condition.
Secondly, sometimes Dermatologists do a scraping for a Fungal Culture test or a KOH test to evaluate whether a yeast of fungal organism is involved - causing a true skin infection. The results of a Fungal culture take a full month, so we sometimes start treatment before we have this test result back from the laboratory. The results of a KOH test take only a few minutes.
Thirdly, a third type of testing – Allergy Patch Testing – can be quite helpful in evaluating for trigger factors of Urticaria or Hives. In my Memphis Dermatology practice, at Rheumatology and Dermatology, I have been offering Allergy Patch Testing since 2004. I am also a member of the American Contact Dermatitis Society, an 1100-Dermatologist organization focused on this type of testing that meets as a society at least once a year to discuss updates on the panels of chemicals to which we offer testing. For instance, the 2023 yearly meeting, of which I was an attendee, was over in New Orleans, Louisiana, attended by over 100 Dermatologists from all over the world, a meeting focusing upon Urticaria and Contact Dermatitis. For more on Allergy Patch Testing, see the page on Allergy Patch Testing on this same web site: https://www.Rheumderm.com.
What treatment options tend to be helpful for patients with Urticaria or Hives?
Dermatologists often consider either oral steroid tablets (called prednisone or methylprednisolone tablets) or a steroid shot (called a Medrol Shot) for patients with severe reactions. We also commonly consider one of about sixty “topical steroid creams or ointments,” meaning prescription medicines for use “on top of” or “superimposed upon” the skin. These include Clobetasol, Halobetasol, Diflorasone diacetate, and Betamethasone dipropionate cream. These topical steroids are available as creams, ointments, foams, sprays, gels, and many other types of preparations, depending upon what type of substance the medicine is put into – what type of “vehicle” is involved. So Dermatologists such as myself work to develop a ‘care plan’ that uses the most appropriate prescription product to match the condition that our patients are suffering from.
Can the office recommend any cosmetics or toiletry products if I am found to have reactions to certain chemicals?
In addition to being a Cordova Dermatologist, I am the President of Big River Silk™ Skincare, focused on skincare products with lower risk of allergies for people of all ages, from babies to seniors, using a minimal number of chemicals, to minimize the risk of allergic reactions. We offer HypoShea Moisturizer Cream, free of fragrances, dyes, and propylene glycol, as well as HypoShea Oil, convenient for use after bathing or showering (1 oz: $7.97/2 oz: $12.95), and also a new preparation as of 2022: HypoShea Moisturizer Lotion, which is less moisturizing and also fragrance-free. All Big River Silk Skincare products are available in 1 oz: $12.95/2 oz: $18.95/4 oz: $29.95/8 oz: $39.95, on-site at our international headquarters at 8143 Walnut Grove Road, Cordova TN 38018 (1-901-753-0168). Of products can also be ordered at https://www.Bigriversilkskincare.com ($5.00 shipping and handling for orders under $40.00, otherwise free shipping and handling ($10.00 for Canadian orders under $75.00).
All products are available at www.Bigriversilkskincare.com, or at our international headquarters, at 8143 Walnut Grove Road, Cordova, TN 38018, Monday-Friday, from 7:30 AM to 4:30 PM. Or you can call us at 1-901-753-0168. We do offer free shipping and handling or US orders above $40.00 ($70.00 Canadian). Otherwise, $5.00 shipping and handling for US orders/$10.00 Canadian.
If you or a friend would like to come in for a skin consultation, my Memphis Dermatology practice has been with Rheumatology and Dermatology, 8143 Walnut Grove Road, Cordova TN 38018 since 1993 (1-901-753-0168). Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology website, https://www.AADA.org, then plugging your zip code into the “Find a Dermatologist” tab. Never itch in silence!
George Woodbury Jr. M.D.
Board-certified Memphis Dermatologist at Rheumatology and Dermatology Associates PC
8143 Walnut Grove Road
Cordova TN 38018
President of Big River Silk Skincare Inc.