Sunday, June 7, 2020

What if my hives bruise, blister, scar or heal with marks on skin?

There are some clinical features that can help a physician to distinguish whether the chronic hives may be the idiopathic kind or the secondary kind. A clue could lie in the answer to a very important question: What if my hives bruise, blister, scar or heal with marks on skin? or leave with no trace leaving a normal looking skin?

Not all chronic hives are the same, look for red-flag symptoms

Most people which chronic hives will have the chronic idiopathic variety as it is the vastly more common of the two. There are some features that can distinguish the more benign chronic idiopathic hives from chronic secondary hives but these are not hard and fast rules. Hives in chronic idiopathic urticaria are usually transient, fleeting (appear and disappear in less than couple hours, at most 1 day only to reappear in another location – thus they tend to ‘move’ around), they go away leaving a normal looking skin, and never blister, scar or heal with discolored bruises. All these properties (lasting longer than a day, don't move around and have some of the other skin changes) are often seen in chronic secondary urticaria, since main driver of hives in this case (and the skin changes) is a ‘bad’ type of inflammation.

The major types of chronic urticaria


Chronic idiopathic urticaria, can be further divided into chronic spontaneous urticaria (hives that come on their own without any provocation or trigger) or chronic inducible urticaria (hives that be induced by physical triggers like pressure, scratching the skin, hives from sunlight, heat etc). There is a large degree of overlap between these two clinically, and it is rare to find a pure inducible urticaria patient as most will have some component of spontaneous hiving.

There is a special type of chronic idiopathic urticaria, a third variety that has a mix of idiopathic as well as secondary urticaria features. This is called chronic autoimmune urticaria (confusing nomenclature but that's how it is widely known). This urticaria overall behaves like the idiopathic chronic hives clinically (skin changes similar to idiopathic kind) but is associated with presence of autoimmune antibodies to thyroid (TPO or thyroid peroxidase antibodies) . These auto-antibodies give rise to the ‘autoimmune’ in the name but are thought to have no role in the causation of hives. Some experts seem to think that presence of these TPO antibodies is a marker that these hives could last longer or be more difficult to control, but they themselves have no role in the development of actual hives.

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