Hives are one of those things that you hear about so often that it feels like you should know what they are, how to spot them and how to treat them. But the truth is that many of us are undereducated when it comes to this itchy rash. And we should all get familiar with hives because they are quite common.
Hives are itchy pink welts that could appear anywhere on the skin. They can vary in size, and hives sometimes merge together to cover large patches of your skin. That means that what may appear to be one giant hive could actually be several smaller ones.
Individual hives usually go away in less than 24 hours, but new ones can appear. All told, you might battle a case of hives for up to six weeks, according to the American Academy of Dermatology (AAD).
“They tend to come on suddenly and they are incredibly itchy. People are miserable with them. They might only last a few hours then they’re gone. Or they might come back later in a different spot,” said Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic and a member of the American Academy of Dermatology.
The good news is that, while breaking out in hives is an uncomfortable experience, they are also temporary. “For most people who have hives, the episode will end, and their skin will be better within a few days. If that’s not the case, you should see your dermatologist,” she said.
Hives are common — and anyone can get them. According to the American Osteopathic College of Dermatology (AOCD), 20 to 30 percent of people will get hives at least once in their lives.
Symptoms of hives
What do hives look like? They may look a bit different on everyone, but hive symptoms generally include slightly swollen, raised pink or red areas on the skin. You may see hives alone or in a group, or connected together to cover a lot of your skin. They don’t blister.
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“Hives are something that by definition are going to be transient. The lesions come and go within 24 hours. If you have something hanging around for longer than that, it’s not a hive,” said Dr. Jenny Murase, associate clinical professor of dermatology at the University of California, San Francisco, and a member of the American Academy of Dermatology.
It’s rare, but possible, that your hives could cause swelling of your lips or tongue or itching in your mouth or throat. If you notice those symptoms, go to the emergency room, Piliang said. You’ll need medical care to make sure your airway doesn’t close from the swelling.
Causes of hives
It’s likely you may never know what your triggers are. For 95 percent of people with chronic hives, there’s no identified cause, according to AOCD.
It’s worth seeing a dermatologist for evaluation, though, because you could be in that 5 percent of people who can determine their causes for hives.
Your hives could be caused by:
- Insect stings or bites
- An underlying disease or condition
- An allergic reaction
- An overactive immune system
- Medication
- Foods and drinks, such as citrus fruits, milk, eggs, peanuts, tree nuts and shellfish
- Stress
- Sunlight
- Pollen
- Cold
- Pressure
- Vibration
- Exercise
- Scratching or rubbing the skin
- Getting hot and sweaty
Sometimes you’ll notice hives right after you’re exposed to a trigger. But your reaction could also start up to two hours later, according to the AAD.
Does stress cause hives?
There's also some evidence to suggest that there's a relationship between hives and stress. A 2018 study found that people who experience chronic breakouts of hives also have higher rates of stress. But, scientists are still trying to understand the relationship between hives and stress. A 2020 study suggested that there may be a relationship between high levels of stress and inflammatory skin responses.
That doesn't mean that stress will necessarily cause hives in everyone, though. The relationship between hives and stress is strongest for people who have autoimmune condition or have other allergy issues and are predisposed to getting hives.
But, let's be honest, it can be stressful to break out into itchy rashes, and unfortunately high levels of stress can also prevent your body from healing quickly from inflammatory skin conditions.
Diagnosing hives
To diagnose hives, your dermatologist will examine your skin and ask questions about your symptoms and possible causes. If you develop repeated cases of hives you may want to keep a symptom diary to share with your doctor. Tracking your symptoms and possible triggers could help identify the cause of your hives.
Your dermatologist may also recommend allergy tests, blood work or a skin biopsy, according to the AAD.
Are hives contagious?
There's no evidence to suggest that hives are contagious, but whatever is causing the hives could be. In other words, if you break out in hives, no one is going to get infected by being in contact with you. But if your hives are caused by an insect bite, someone else who gets bitten by that insect may also develop hives.
Treatment for hives
Antihistamines are the go-to treatment for hives, according to the AOCD. But there are some key factors to consider.
The AOCD says it’s important to:
- Find an antihistamine that’s strong enough
- Use the right dosage
- Continue the antihistamine for long enough to ward off future outbreaks
“A mistake people will make is they take antihistamines for a few days and then they go off them, and it starts up again,” Murase said. “What you want to do is shut the cycle down — take enough antihistamine so it quiets.”
If you don’t get good results with antihistamines your doctor might recommend steroids or other medications.
You can alleviate the itching from hives with an ice pack. “Cold and itch run on the same nerve pathways — you can’t feel both at the same time,” Piliang said. “So if the hives are super itchy, putting an ice pack on them can help.”
And, while having hives is no fun, try to remember that it's a temporary condition. If you're already feeling icky, you don't want to add in the extra stress of fixating on the hives.