The Bare Skinny
by Dr. Coco Toledo, MD, FPDS
Chairperson, PDS Committee on Publications and Library (2007-2008)

Wheals – They Come and Go - JULY-AUGUST 2007!

Ever experienced using a skin product or taking a medication that caused you to break out in islands of swollen, angry red, itchy skin? That's what wheals (a.k.a. hives) are like.

In medical parlance, the reaction is what is referred to as urticaria - a condition where red, swollen, itchy, evanescent skin lesions (wheals) appear, lasting a few minutes to a few hours but no more than 24 hours.

Ever seen someone's face balloon to frightening proportions as a reaction to a chemical--say, hair dye? Imagine swollen eyelids shut tight or super puffy, puckered lips.

This is called angioedema .

About one in five people experience urticaria and/or angioedema in their lifetime. For those who suffer urticaria alone, 50 percent resolve within a year. But twenty percent continue to be plagued for over 20 years.

Quite a common occurrence then -- so you may have heard the term before. But what are hives really ?

Many conditions trigger this reaction wherein the skin's blood vessels dilate and “leak” fluid out into the skin and the fat beneath it.

When leaked fluid is located in the skin alone, it is known as urticaria. When it involves the fat layer beneath the skin, it is known as angioedema

The problem with urticaria is precisely that, by definition, they come and go. Hence, people usually don't seek help from a dermatologist until it significantly affects quality of life. Translation: The condition has become chronic (recurring for over a month) and frequent (occurring daily).

Also, people have a knee-jerk diagnosis for it – “It's the chicken/ fish/ seafood I just ate” or “It's something in the air” – and self medicate with anti-itch tablets.

While particular foods and allergens in the air are legitimate triggers of urticaria, here's the thing: What else could it be that you may be missing out on simply because you did not know?

The line of “suspects” will be systematically ferreted out, the contributory factors in your lifestyle reviewed by your skin doctor as he investigates your condition.

You might be surprised to discover that proper consideration to not one but multiple factors might do the trick of significantly suppressing, even ridding yourself of the malady.

Consider these:

• Patients with a history of atopic dermatitis, asthma, and allergic rhinitis are more prone to urticaria;

• Certain foods trigger urticaria: Nuts, seafood, eggs, cheeses, foods that contain salicylate, tartrazine (in vitamin and birth control pills) or azo dyes, even some fruits like bananas or grapes;

• Inhalants like pollen and animal danders are well-known triggers;

• Contactants -- materials or substances that directly contact the skin -- are common culprits: Cosmetic products (dyes, hair and nail polish), toiletries (toothpaste, mouthwash, soap), fragrances, insect repellant, chemicals in the workplace, fabrics like silk and wool;

• Infections (bacterial, fungal, viral) and infestations (scabies, intestinal parasites) can manifest with urticaria. Treat the cause and the urticaria resolves;

• Commonly used medications -- (1) anti-inflammatory drugs like aspirin and indomethacin, (2) antibiotics like penicillin and sulfa drugs, (3) ear or eye drop medications, (4) even anti-hypertensive drugs like ACE inhibitors -- may be causing or aggravating the problem;

• Have you undergone some diagnostic tests recently? Contrast dye injected into veins to investigate various diseases can cause urticaria (and a study suggests that women are more at risk!).

• Do you engage in outdoors-y activities? Are you exposed to the elements? Is your body adjusting to an extreme change of climate? Physical stimuli like heat, cold, or sun exposure may cause skin cells to release chemicals that cause urticaria;

• Systemic diseases like lupus erythematosus hyperthyroidism, lymphoma, and certain hereditary disorders need to be ruled out when suspected.

A sobering fact, though, is that amongst those afflicted with chronic urticaria, the cause is unknown in at least 50 to 70 percent. This, however, does not preclude the usefulness of seeking help from the dermatologist or other medical experts.

The bottomline? You can only benefit from a rational, medical management and receive a more directed therapy. Do avoid the grope-in-the-dark, old-wives'-tale approach and spare yourself the agony of potential complications from inappropriate drug use and delay in diagnosis.

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