What does CSU look and feel like?
Hives are raised, red, itchy bumps or welts on the skin. Sometimes it's big, sometimes it's small. The area may feel warm to the touch.
CSU is also known as chronic idiopathic urticaria (CIU). Hives can appear anywhere on the body. You may notice that certain areas are more affected than others.
For CSU, hives usually last between 30 minutes and 24 hours. They may come and go. This cycle can occur frequently.
Severe or long-term CSU may cause other symptoms, such as headaches. Fatigue; pain or swelling in the joints. Your face, neck, or upper chest suddenly turns red. Wheezing; stomach symptoms such as diarrhea. or a fast heart rate.
„CSU can cause angioedema and swelling with urticaria,“ says Dr. Gupta. „You may notice swelling in your lips, cheeks, around your eyes, arms, legs, and genitals.“ You may also experience numbness or tingling.
How do I know it's CSU?
There are no specific tests to diagnose CSU. Your doctor will evaluate your symptoms and how long they have been present.
„If you have hives most days of the week for more than six weeks, you may have CSU,“ says Dr. Gupta.
Who gets a CSU?
Anyone can have a CSU. Women get this disease twice as often as men. It usually begins in your 20s, 30s, or 40s, but it can appear at any age.
CSU is more likely to occur if you have allergies, eczema, asthma, or food allergies.
What causes CSU?
For up to 95% of people with chronic hives, the condition is „idiopathic.“ This is a medical term meaning there is no clear cause.
„It can happen almost anything,“ says Dr. Anna Chacon, a Miami-based dermatologist. „There are usually certain environmental factors that cause it.“
This condition may be related to another health condition, such as thyroid problems, liver problems, skin disorders, or sinusitis.
In about half of cases, the body's immune system may be overactive and attacking healthy tissue.
Patients with CSU are more likely to suffer from autoimmune diseases. „Conditions such as thyroid disease, celiac disease, Sjögren's syndrome, lupus, rheumatoid arthritis, and type 1 diabetes are more common in CSU patients than in the general population,“ says Dr. Gupta.
What makes CSU even worse?
With CSU, certain things can cause a flare-up or make your hives worse.
Common ones include:
- alcohol
- cold
- exercise
- heat
- hot shower
- humidity
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
- rubbing or scratching the skin
- Spicy food
- tight clothing
Stress can also be a trigger for CSU, according to Gupta. “I find that many of my patients come to me with symptoms after stressful events in their lives.”
Physical pressure can cause hives. For example, carrying a heavy bag on your shoulder can cause hives to appear there.
Identifying your triggers may help you manage your symptoms. „In some cases, avoiding the trigger may help prevent a flare-up,“ Chacon says.
How is CSU treated?
The first step is to learn your triggers and avoid them as much as possible.
If you develop hives, you can try non-drowsy oral antihistamines such as cetirizine, fexofenadine, or loratadine. At night, sedating antihistamines such as cyproheptadine, diphenhydramine, doxepin, or hydroxyzine may be used.
„We often use high-dose oral antihistamines,“ says Gupta. However, for this to be effective, the drug must be sufficiently effective, the dose must be high enough, and it must be taken for a long enough period of time.
If these are not enough, your doctor may recommend a course of steroids followed by antihistamines.
Your doctor may also recommend other medications that are known to be effective for some people with CSU, such as antacids, anti-inflammatory antibiotics, and biologics.
Is CSU dangerous?
Hives themselves are not dangerous. But they can also be frustrating, says Gupta. In severe cases, it can interfere with work, school, and sleep, affecting quality of life.
Although rare, in some cases CSU may be associated with more severe conditions or allergic reactions such as anaphylaxis. Consult your doctor for more information.
Your doctor may want to test you for an autoimmune disease, especially if there are signs that something else may be going on.
Will CSU disappear?
There is no cure for CSU. „But in some cases, it can go away on its own,“ Chacon says.
In 30% to 50% of cases, symptoms disappear within a year after diagnosis. However, symptoms may persist for more than 5 years. The average is 1 to 5 years.
When should I see a doctor for CSU?
„If you're experiencing discomfort and can't control it, see your doctor,“ says Dr. Gupta. „If you wait and let it get worse, your hives can be harder to control.“
If there are no hives during the examination, take a photo and show it to your doctor.
Patience is key. Managing your condition may take time, but if you and your doctor work together, you can find an effective treatment plan.