Urticaria (Hives)


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Urticaria (Hives):

Urticaria (Hives) Dermatology Module Family Nurse Practitioner Program University of Southern Mississippi K. Michelle Pendergrass PhD(c), PNP, FNP-BC


Etiology Common vascular reaction pattern Histamine release from mast cells in the dermis

Causes of acute urticaria:

Causes of acute urticaria Idiopathic #1 Foods Fish Shellfish Eggs Nuts Strawberries Infections #2 Viral Bacterial Insect stings Drug reactions Aspirin NSAIDS Alcohol Codeine Morphine Penicillin Sulfonamides Thiazides


History Transient migratory wheals Individual lesions last <24 hours Marked pruritis F>M May be acute <6wk or chronic >6wk


Physical Annular or arciform erythematous , edematous papules and plaques; may become confluent to form serpiginous or polycyclic patterns

Differential diagnosis:

Differential diagnosis Insect bites Urticarial bullous pemphigoid Mastocytosis Erythema multiforme Urticarial vasculitis Angioedema


Diagnostic Often none in acute Tests to confirm suspected causes: CBC, ESR, CF, TSH, ASOT titers, U/A, stool for O&P; skin biopsy if >24hours Consider workup if chronic


Plan/Management Ask about facial edema or difficulty breathing, which may be warning signs of systemic anaphylaxis Identify and eliminate etiologic agents Avoid aggravating factors Minimize stress, heat, alcohol

Symptomatic Relief:

Symptomatic Relief Mild: Low sedating H1 blockers ( Zyrtec ) Moderate: Doxepin hs Severe: Prednisone taper x 3wk for symptomatic relief (avoid in chronic cases) Epipen if severe reaction

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