Hives (Urticaria) Dermatologist2019-06-11T09:52:47+00:00

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Urticaria (also called hives, welts or wheals) looks like nettle rash. It is common, and we see it in 20% of the population.

IN THESE VIDEOS, I EXPLAIN THE SYMPTOMS AND CAUSES OF HIVES – AND HOW TO TREAT THEM

In the videos above, I explain things in a simple way that applies to most people who have hives. Of course, no video or website can replace the value of a personalised consultation. At your consultation, you can have your skin carefully examined and get an expert recommendation to help you resolve your condition.

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Treatment enables people of all ages take control of their skin condition and get their life back

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How does urticaria impact people on a day-by-day basis?

EPISODES CAN CAUSE DISTRESS DUE TO ITCHING AND APPEARANCE

A raised, itchy red rash

Symptoms of urticaria include itchy, red wheals that can be round, ring-like or linear. Urticaria can affect any part of the body. Usually, individual lesions of urticaria resolve within 24 hours, but episodes can last longer.

It’s usually gone in a few days

Episodes of urticaria can cause distress due to the itching and appearance. In angioedema, the lip, tongue and other soft tissues can swell alarmingly. Thankfully, urticaria is not typically life-threatening and causes no lasting effect on the skin.

Sometimes acute, sometimes chronic

Many rashes clear up in days or at most weeks. In some cases, the rash comes and goes for more than 6 weeks, often over many years. Children and adults alike are often affected by the condition.

Living with any long-term skin condition can be difficult

Chronic urticaria can have a considerable negative impact on a person’s mood and quality of life. Living with itchy skin can be particularly upsetting. Stress, anxiety, and depression appear in 1 in 7 people.

Is there hope for people with urticaria?

Antihistamines can help relieve symptoms. If they do not settle the problem, I have other options that are extremely effective.

What my patients love about my service

MY PATIENTS ARE MY BEST PROMOTERS

Please pass on my thanks to Dr Pratsou for her assessment on my continued taking of roaccutane.

She was completely right, I didn’t need a new course, I needed to move away from the drug. The creams she gave me and Cetaphil recommendation have meant my skin has been the best it’s ever been (ongoing and since I saw her) ALL SUMMER :))))) I’ve had zero problems…and I’m loving it.

Thank you once again.


Phillip, Acne

“Dear Dr Pratsou,

Following the consultation today I feel it appropriate to say thank you for your help in dealing with my rosacea.

On each occasion, I have visited your department I have noticed the kindness and cheeriness of all the staff I have encountered and particularly wanted to say that you made me feel at ease with your calmness and excellent manner.

All is much appreciated.”


Anne, Rosacea

“Thank you very much!!

You three were (and are) a great team!

I will remember you.

You made me feel comfortable.”


Ellie

“Tania,

Please pass to Dr Pratsou my thanks for her skilled work.

The wound is healing beautifully and now the stitches are out it looks as though it will be almost invisible once fully healed.”


Graham, Skin cancer removal

“Dear Dr Penelope, Rena & the team, (I can’t remember the nurse’s name who helped me during my 2 procedures at the Spire!)

I wanted to thank you for your support and help during a very difficult time. You guys do a wonderful job – and we are eternally grateful for your help.”


Clarissa, Skin cancer

“I would like to put on record how impressed I was with the operation you performed for the removal of the SCC on my neck. I cannot even see where the cut or the stitches were! I am indeed very grateful for the excellent work you do.”


Harry, Squamous Cell Carcinoma

“Dear Dr Pratsou,

I am very grateful to you for your diagnosis, recommended treatment and advice. Your letter to my GP sets out both the course of events, and your own analysis of probable condition and possible cause, clearly summarising our discussion.

I hope there will be no recurrence but I will certainly come back to you if there is.”


Ryan, Skin rash

“Dear Tania,

Please pass on my thanks to Dr Pratsou. I saw her this morning for a mole check. She was so lovely and reassuring. Please also thank the two nurses who assisted her during the mole removal procedure. I was very nervous, but they were very efficient, which meant I did not have too long to think about it, but most of all they were very kind. They kept me distracted and calm, which made a huge difference. Thank you also for your efficiency in both booking me in so quickly.”


James, Mole removal
Dear Ms. Pratsou,

I am writing to thank you for the care you have given me in the past few months. From the moment I walked into your consulting room with a lesion on my cheek, a lesion that I fully expected to be some sort of skin cancer (and it was), you have been thorough, reassuring, respectful and in every way professional.

You recognised that I had some insight into the condition of my skin and the procedures required to treat me. You listened to me. You projected expertise and compassion.

During the procedure to remove the growth you ensured that the atmosphere in the treatment room remained not only calm, but actually pleasant. Had it not been that you were excising a growth and sewing me up, I almost felt as if you, me and the nurse were at some sort of women’s discussion group. The time flew by. I had zero anxieties about the procedure and as we both know now, the wound healed flawlessly.

Thank you for your expertise and your communication skills and all round good nature. I feel very lucky.


Karen Tatom, Skin cancer removal

We have replaced the images and names of real patients who provided these testimonials to protect their privacy.

The first step to feeling in charge of your skin is to book an initial consultation

FIND OUT HOW TO GET THE SKIN YOU WANT

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How it works

FEEL IN CHARGE OF YOUR SKIN IN 3 EASY STEPS

STEP 1 – CALL US
STEP 2 – LET’S MEET
STEP 3 – RESOLUTION
CONTACT MY STAFF

Give us a call on 0118 373 5198 and we’ll help guide you towards a first appointment.

MEET WITH ME

I’ll see you and examine your skin before I recommend treatment. In some cases, I can begin treating your condition on the same day.

FEEL IN CHARGE OF YOUR SKIN

I’ll guide you down the road towards a resolution of your skin condition so that you can get back to normal life.

More information about the hives (urticaria)

FOR THOSE WHO WANT THE DETAILS

Urticaria (also called hives, welts or wheals) looks like nettle rash.

Urticaria is common, and we see it in 20% of the population.

Pink or white raised areas, which can be, round, ring-like or linear are signs of urticaria.

Individual lesions come and go within 24 hours. The condition, however, can last longer.

Urticaria sometimes occurs with more profound swelling, (known as angioedema) commonly in the lips and tongue.

We tend to divide urticaria into acute (less than 6-12 weeks) or chronic (lasting longer than 6-12 weeks).

Symptoms of urticaria include itchy, red wheals that can be round, ring-like or linear.

Urticaria can affect any part of the body. Usually, individual lesions of urticaria resolve within 24 hours, but episodes can last longer.

Episodes of urticaria can cause distress due to the itching and appearance.

In angioedema, the lip, tongue and other soft tissues can swell alarmingly. Thankfully, urticaria is not typically life-threatening.

Acute urticaria, with or without angioedema

50% of incidence is due to upper respiratory tract infection, which tends to run its course.

Chronic spontaneous (previously known as idiopathic) urticaria

There is no known cause. However, some experts think it is perhaps an autoimmune response. Evaluators have found circulating antibodies in the bloodstream of some patients, though testing is not usually necessary as it doesn’t confer any benefits.

Some chronic cases of urticaria can have specific triggers, for example, heat, cold, friction, pressure on the skin, or (rarely) water or sun exposure. We call these types physical urticarias.

Quite often there is nothing to see on the skin during a consultation.

I can often base the diagnosis on your clinical history and the results of simple tests I conduct during the appointment. In some cases of chronic urticaria, I may offer you blood tests, but these are not always necessary.

Patients often bring pictures captured during flares, and these can be useful if the rash is not present at the time of the appointment.

Antihistamines block histamine release and relieve symptoms. You may need a higher dose of antihistamines than you have previously been prescribed, but we can safely continue these until your symptoms settle.

If antihistamines do not fully settle the problem, Montelukast can be added. Montelukast is a leukotriene receptor antagonist that has been used in asthma for many years.

Oral steroids should not be routinely used but are rarely needed during severe flares.

A new treatment called Omalizumab (Zolair), is a biologic therapy in the form of injections, which is extremely effective and can be used in moderate to severe chronic spontaneous urticaria.

What am I allergic to?

While hives can look like an allergic reaction, urticaria is rarely due to an allergy.

Should I avoid specific foods?

Urticaria is rarely due to food allergy in adults, though very occasionally food additives can be to blame.

In chronic spontaneous urticaria, some people choose to follow a pseudoallergen-free diet to avoid excessive histamine release. This type of diet, however, can be extremely restrictive.

Alcohol (specifically, red wine) can facilitate histamine release. Therefore, you should avoid it if you notice it causes flares.

What else can I do?

If at all possible, avoid taking aspirin, naproxen and other NSAIDS (Non-steroidal anti-inflammatory drugs), as well as codeine.

If you are already on this medication for a medical condition, please seek the advice of your GP before discontinuing such treatments.

With physical urticarias, I advise that you avoid known triggers (for example, tight clothing) if possible.

Are treatments safe to take for this long?

Antihistamines are the mainstay of treatment and are very safe even if you use them long term.

There are specific medical contraindications, and I recommend we discuss any concerns face to face.

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Questions and answers

RELEVANT AND INFORMATIVE VIDEOS AND ARTICLES

About the author

Dr Penelope Pratsou | Consultant Dermatologist

MBChB, MRCP (UK) (Dermatology)

I’m Dr Penelope Pratsou, a skilled independent Consultant Dermatologist based in Berkshire. I have specialist expertise in the diagnosis and management of all skin cancers, and in performing mole checks. I’m a trained skin surgeon and remove skin cancers, moles, skin tags, cysts and warts.

I also have invaluable experience in dealing with all skin conditions, from the common skin complaints of acne, rosacea, eczema and psoriasis, to the rarer and more complex skin problems, having seen it all through years of NHS work.

After I obtained my Membership to the Royal College of Physicians, I undertook rigorous specialist training in dermatology, before being appointed as a Consultant Dermatologist at the Royal Berkshire Hospital, Reading. There, I helped set up and lead a busy clinic for the diagnosis and treatment of suspected skin cancer. I was also actively involved in supervising and training both dermatology and GP trainees.

Alongside my increasingly busy private practice, I have maintained an NHS practice in Oxford in order to continue to engage with challenging cases and to develop my specialist interest in skin allergy.

Learn more about me

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