Hives (Urticaria)

What it is

Hives are characterized by raised, red welts, similar to insect bites, that itch intensely, move to different spots and fade within 24 hours, while new lesions keep appearing. They can come with angioedema, a deeper swelling of the lips, eyelids or hands. The acute form lasts up to six weeks and is usually related to infections, medications or foods; the chronic form persists longer and, in most cases, is spontaneous, with no identifiable external cause. At Femi Saúde, Dr. Ana Kappes distinguishes the types of hives, investigates possible triggers, controls symptoms with appropriate medication, and follows up until remission.

Most common symptoms

• Raised, red welts that itch
• Lesions that move to different spots within hours
• Swelling of the lips, eyelids or hands
• Repeated flare-ups over weeks or months
• Worsening with heat, pressure or friction on the skin
• A burning or stinging sensation

Causes and risk factors

• Viral or bacterial infections
• Medications, such as anti-inflammatories and antibiotics
• Foods and food additives
• Physical stimuli: cold, heat, pressure or sun
• Autoimmune mechanisms in chronic hives
• Stress as an aggravating factor

How it is diagnosed

The diagnosis of hives is clinical, based on the description of the lesions, their duration of less than 24 hours at each site, and the pattern of flare-ups. Photos of the welts help when they have already faded by the time of the consultation. The dermatologist asks about medications, recent infections, foods and physical stimuli, and in chronic hives may order basic blood tests, such as a complete blood count and inflammatory markers, as well as specific tests when inducible urticaria is suspected. Lesions that last more than 24 hours and leave marks require a biopsy to rule out vasculitis.

How we treat it at Femi Saúde

First-line treatment is second-generation antihistamines, which do not cause drowsiness and can have their dose increased up to fourfold under guidance. Identified triggers, such as certain medications or physical stimuli, should be avoided. Oral corticosteroids are reserved for intense flare-ups and used for a short period. In chronic hives that do not respond to antihistamines, omalizumab, a biologic, and other modern treatments offer excellent control. In all cases, the dermatology team at Femi Saúde escalates treatment according to the response, advises on warning signs, and gradually reduces medication once the condition stabilizes.

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