Does scratching make hives worse

9 Ways to Ease the Itch of Chronic Hives

They're itchy, red, and raised and often appear at the worst possible times. About 20 percent of the population will get them at least once in their lives, according to the American College of Allergy, Asthma & Immunology. They're hives. And hives that last more than six weeks are considered chronic (persistent or recurring). For some people, these hives are a result of allergies, but for others there's no discernible cause. Chronic hives with no known cause are called chronic idiopathic urticaria (hives).

The itching associated with these hives, which stems from the release of natural chemicals called histamines by your bodys immune system, can dramatically affect your quality of life. This is among the main findings of a study published in August 2015 in the journal Annals of Allergy, Asthma & Immunology. Still, there's a lot you can do to ease the itch of chronic hives.

How to Prevent Scratching When You Have Chronic Hives

Updated on March 13, 2024

Chronic spontaneous urticaria (CSU) is a condition that causes recurring episodes of hives or whealsswollen, raised, itchy welts on the surface of the skin. In addition to hives, some people with CSU also experience angioedema, which is swelling in deeper layers of the skin.

The defining characteristic of CSU is that symptoms appear without any apparent or identifiable or consistent triggerin other words, the cause is unknown. For many people, these symptoms occur every day or nearly every day. For hives to be diagnosed as chronic, symptoms need to last for six weeks or longer. (Hives that last for fewer than six weeks are not considered chronic and are called acute spontaneous urticaria). While six weeks is the minimum, many people experience symptoms for months or years.

While the condition resolves within a few years in many cases, it requires treatment.

The impact of itch

Mentioned above, itching is one of the main symptoms of CSU. Itch can manifest as a stinging, burning, or tickling sensation, or another irritating sensation that causes the desire to scratch.

With CSU, itching can be intense and severe. Itch can be a frustrating and distressing symptom. It can have a significant impact on a persons quality of life, disrupting sleep and many aspects of everyday life.

The importance of avoiding scratching

If you are experiencing itch, its important to avoid scratching as much as possible. Reasons to avoid scratching include:

• Scratching can make itching worse. Scratching causes the release of a substance called histamine, which triggers more itching.
• Scratching can trigger hives. Scratching, rubbing, and pressure on the skin can also trigger hives and angioedema for some people. Usually this is associated with inducible urticaria, but a person can have both inducible and spontaneous urticaria at the same time.
• Scratching can damage the skin. Damaged skin is more susceptible to infections. Damaging the skin can also lead to scars and other skin changes.

Strategies to avoid scratching

Its important that your treatment plan include strategies to reduce itch and prevent scratching. The first and most important strategy is to work with a healthcare provider. Based on your symptoms, your overall health, and other factors, your healthcare provider can prescribe medications to help control hives and itch. A healthcare provider can also help identify any health condition that may be causing or contributing to hives.

Additionally, you can try these strategies to cope with itch without scratching:

• Apply an anti-itch cream. Ask your healthcare provider about over-the-counter medications that can be applied to the skin to help ease itch, such as calamine lotion. Always tell your healthcare provider about any and all medications and over-the-counter medicines you are using.
• Apply moisturizer. Applying moisturizer can help ease itch. Choose fragrance-free moisturizers. Keeping the skin moisturized can also prevent itch by preventing dry skin.
• Apply a cold compress. A cold compress is a clean washcloth soaked in cold water. However, do not do this if exposure to cold induces hives.
• Find distractions. Find ways to keep your hands busy and your mind distracted when you are experiencing itch. Play a game on your phone, knit, fidget with a toy, meditate, read, or watch a show.
• Scratch something else. Some people with conditions that cause itch find it helpful to scratch something besides their skin when they are itchy, such as a patch of Velcro.

Article sources

Dominique Dabija, Prasanna Tadi, and Gerard N. Danosos. Chronic Urticaria. StatPearls. April 17, 2023.American College of Allergy, Asthma, & Immunology. Chronic Spontaneous/Idiopathic Urticaria (Chronic hives).Thomas M. Ruenger. Hives. Merck Manual Consumer Version. January 2023.Vishakha V. Sinha, Mrunalini Vinay Kalikar, et al. Comparative study of efficacy and safety of cetirizine and bilastine in patients of chronic spontaneous urticaria: Open-label, randomized, parallel-group study. Perspective in Clinical research, 2023. Vol. 13, No. 4.Abhishek De, Kiran Godse, Dhiraj Dhoot, and Aarti Sarda. Real-Life Experience of Efficacy and Safety of Bilastine in the Refractory Cases of Chronic Spontaneous Urticaria and its Effect on the Quality of Life of Patients. Indian Journal of Dermatology, 2021. Vol. 66, No. 2.Yuzhou Huang, Yi Xiao, et al. Association of Chronic Spontaneous Urticaria With Anxiety and Depression in Adolescents: A Mediation Analysis. Frontiers in Psychiatry, 2021. Vol. 12.Mayo Clinic. Itchy skin (pruritus).Takemichi Fukasawa, Asako Yoshizaki-Ogawa, et al. Pharmacotherapy of ItchAntihistamines and Histamine Receptors as G Protein-Coupled Receptors. International Journal of Molecular Sciences, 2022. Vol. 23, No. 12.Iolanda Alen Coutinho, Frederico Soares Regateiro, et al. Refractory chronic urticaria in adults: clinical characterization and predictors of severity. Allergy, Asthma & Clinical Immunology. Vol. 2020. Vol. 16.Elena Kovalkova, Daria Fomina, et al. Comorbid Inducible Urticaria Is Linked to Non-Autoimmune Chronic Spontaneous Urticaria: CURE Insights. Journal of Allergy and Clinical Immunology: In Practice, 2024. Vol. 12, No. 2.Merck Manual Professional Version. Description of Skin Lesions.American Academy of Dermatology Association. 10 Ways To Get Relief From Chronic Hives.Merck Manual Professional Version. Urticaria.American Academy of Dermatology Association. Hives: Self-Care.National Organization for Rare Disorders. Urticaria, Cold.

Ever wondered why scratching makes itching worse?

Scratching an itch causes the brain to release the mood-regulating and pain-controlling neurotransmitter serotonin, according to new research from Washington University School of Medicine in St. Louis, MO. The researchers suggest that serotonin has the effect of intensifying the itch sensation.

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Scientists know from previous studies that a mild amount of pain in the skin is caused by scratching, which temporarily interferes with the itching sensation. This interference happens because, while scratching, nerve cells in the spinal cord carry pain signals to the brain instead of itch signals.

The problem is that when the brain gets those pain signals, it responds by producing the neurotransmitter serotonin to help control that pain, says senior investigator Dr. Zhou-Feng Chen, PhD, director of Washington Universitys Center for the Study of Itch.

Dr. Chen and team found that serotonin has a muddling effect on the sensation of pain and itch, whereby, as serotonin spreads from brain to spinal cord, pain-sensing neurons instead influence itch intensity.

Based on our own experiences of chronic eczema, Medical News Today asked Dr. Chen if the team found any evidence that serotonin drove the itch-scratch cycle by providing a reward sensation when we scratch.

In chronic itch condition, as you experienced, you probably dont get much reward/pleasure out of scratching, because the goal of scratching is to create pain to inhibit itching, replied Dr. Chen. So in other words, you are forced to choose the lesser of two evils, because pain and itch are antagonistic.

He continues:

Incessant scratching is not due to additive sensation, it is because your scratching does not work. The reason is that, at least from our studies in mice, when you scratch to create pain, the brain in response begins to produce more serotonin to inhibit pain (the brain does not want to have pain in your body). What we found is that while serotonin inhibits itch, it also can activate the itch receptor and make more itching.

Now the more itching you feel, the more pain you would like to create to counteract it, he explains. The result is more itching

The researchers bred mice that lacked the genes necessary for serotonin production. When the serotonin-free mice were injected with a substance that would normally cause itching, the researchers found that the mice did not scratch as much as a control group of mice with the serotonin-producing genes.

Next, the mice that lacked the serotonin genes were injected with serotonin. The injected serotonin caused the mice to scratch in a manner that was consistent with the control group.

The team considered different approaches that might be useful in minimizing the itching sensation. They ruled out suppressing serotonin as although this made the mice less sensitive to itching serotonin is too valuable a chemical in the body.

Growth, aging, bone metabolism, mood and pain are all regulated by serotonin, so blocking this neurotransmitter would have consequences throughout the body. Instead, the team focused their attention on disrupting communication between serotonin and the nerve cells in the spinal cord that relay the itching impulse from brain to skin.

Dr. Chen and colleagues worked to isolate the receptor used by serotonin to activate these cells called GRPR neurons. They achieved this by stimulating itching in the mice using the injected substance and then systematically activated different combinations of serotonin receptors on GRPR neurons.

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Eventually, this process revealed that the receptor 5HT1A activated the itch GRPR neurons in the spinal cord. To establish that 5HT1A was the correct receptor, the team administered a compound to block this receptor in mice, which resulted in the mice scratching much less.

As the team decided against blocking serotonin as a therapeutic option because of the widespread consequences its inhibition would have for the body, we asked Dr. Chen what consequences blocking 5HT1A might have.

5HT1A is widely expressed in the brain, yes, blocking it may have adverse effects, he answered. This will be found out with clinical trials as to whether adverse effects are tolerable.

However, Dr. Chen suggests that, when itch is not present, 5HT1A in other brain areas may not be very active, while in a chronic itching situation, 5HT1A activity may be strongest in the spinal cord, so blocking its activity may have the benefit you need.

Based on the teams findings, Dr. Chen identifies the itch-pain cycle as happening in this order:

• First, scratching causes a sensation of pain
• Then the body makes more serotonin to control the pain
• As well as inhibiting pain, the serotonin activates the GRPR neurons via the 5HT1A receptors
• The activated GRPR neurons then make the itching sensation worse.

Next, the team will continue to work toward better understanding the molecular and cellular mechanisms involved in this cycle.

10 ways to get relief from chronic hives

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A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Dermatologists care for people of all ages.

What causes hives that come and go daily?

Some people experience a flare-up of hives that goes away on its own. Other people may have hives that come and go daily.

Hives are itchy, raised bumps on the skin. Doctors diagnose chronic hives in people who experience them for at least 6 weeks. Each hive typically lasts for 24 hours before disappearing. Usually, the condition does not have an identifiable cause, but sometimes it does.

Some people experience chronic hives due to an underlying condition. Therefore, it is important for individuals to speak with a doctor about hives that keep returning.

Keep reading to learn more about the symptoms, causes, diagnosis, and treatment of hives that come and go daily.

Chronic hives is a condition that causes hives that keep coming back. Each one lasts less than 24 hours but, as old hives fade, new ones appear. If this continues for 6 weeks or longer, a doctor will diagnose chronic hives. Acute hives lasts less than 6 weeks.

The symptoms of both acute and chronic hives are the same. A person will have welts that come and go. In some cases, symptoms can hinder daily activities and impair sleep.

Chronic hives look identical to acute hives. In both cases, they can flare up and resolve, but chronic hives keep coming back for 6 weeks or longer and typically occur daily.

Hives are itchy, raised welts on the skin that may be red or the same color as a persons skin. Hives can develop anywhere on the body, move around, and change shape. They can also appear and disappear suddenly.

Hives usually do not break the skin, but bleeding can occur if a person scratches them.

Chronic hives can happen for various reasons. In most cases, however, it is not possible to identify the trigger.

Chronic idiopathic urticaria

The medical name for chronic hives that have no clear trigger is chronic idiopathic urticaria.

According to the American Osteopathic College of Dermatology (AOCD), the immune system is overactive in about half of people who have chronic idiopathic urticaria. Doctors consider these cases autoimmune, as they stem from the immune system attacking healthy tissues.

However, some research notes that certain bacteria, viruses, or parasites are also associated with cases of chronic hives. Researchers have not proven that these organisms cause the hives, but they may trigger the immune system, which could lead to hives as part of its response to the infection.

Bacterial infections associated with chronic hives include:

Viral infections associated with the condition include:

Parasitic infections associated with chronic hives include:

Autoimmune conditions

Some cases of chronic hives may stem from an underlying autoimmune disease.

Conditions associated with chronic hives include:

Research suggests that 9.8% of people with chronic hives also have autoimmune hypothyroidism.

Physical stimuli

Chronic hives can stem from physical stimulation, such as scratching or rubbing the skin. This is known as physical urticaria or dermatographism. The most common trigger is scratching or rubbing the skin firmly. The hives are not always itchy.

Other physical triggers may include:

• exercise
• cold temperatures
• hot temperatures
• sunlight
• vibration
• pressure

Allergies

As with acute hives, chronic hives can also occur due to an allergy. However, unlike acute hives, this is a rare cause for chronic hives.

Some common allergens that can trigger hives include:

• certain foods
• food additives and preservatives
• latex
• medications

Reactions to medications can happen at any time after someone starts taking one. Some common triggers include:

Diagnosing chronic hives may begin with consulting a primary care physician, an allergist, or a dermatologist. They will examine the hives and ask the person questions to rule out common causes, such as a medication reaction.

A doctor may order diagnostic tests to check for other conditions that could be causing symptoms. This could include allergy testing, blood tests to detect inflammation markers, or tests for celiac disease or thyroid problems.

If the hives are not always apparent, it may help for a person to take photographs to show a doctor at the appointment. Keeping a diary of when the hives appear and any possible contributing factors may also help. People can track:

• food they eat
• medication they take
• exposure to physical stimuli, such as the sun, friction, or pressure on the skin

In cases where there is no clear cause, treatment focuses on managing the hives.

A doctor may recommend the following treatment options:

• Second-generation H1-antihistamines: This is the first-line treatment for chronic hives, and includes drugs such as cetirizine and loratadine. Routine use of first-generation H1 antihistamines, such as diphenhydramine (Benadryl), is not recommended by doctors due to sedating side effects.
• Omalizumab (Xolair): If symptoms do not respond to the first-line treatment, practitioners may add Xolair for a second-line treatment. It is a monoclonal antibody, which blocks the action of substances in the body that produce hives.
• Cyclosporine (Gengraf): Doctors may prescribe this when someone does not respond to a combination of an H1-antihistamine and omalizumab.
• Corticosteroids: Short-term use of these anti-inflammatory drugs may be an option to alleviate flare-ups of chronic hives. They are not suitable for long term use due to the risk of cataracts and other possible adverse effects.

If a person knows the trigger, avoiding it can help manage symptoms.

Chronic hives can go away. One study found that 35% of participants with chronic hives had no symptoms after 1 year, and another 29% experienced a reduction in symptoms during this time.

Among individuals with idiopathic chronic hives, 48% experienced remission within 3 years. However, only 16% of those with physical hives experienced remission within 3 years.

If a person has flare-ups of hives for 6 weeks or longer, the American Academy of Dermatology recommends visiting a board-certified allergist, dermatologist, or primary care doctor.

If someone experiences severe hives inside their mouth or airways that affect breathing, call 911 or the number of the nearest emergency department. This could be a sign of a severe allergic reaction, or anaphylaxis, which can make it hard to breathe and can be life threatening.

Here are some questions people often ask about chronic hives.

Why am I getting chronic hives?

In many cases, it is not clear what is causing hives. However, they may be linked to allergies and some immune conditions, such as lupus and celiac disease. Physical stimuli for instance, heat, pressure and vibration may also contribute.

Will chronic hives ever go away?

Chronic hives can go away over time, or symptoms may improve. However this does not happen for everyone. If hives go away, they can also come back in some cases.

How can I get rid of chronic hives?

It might not be possible to get rid of chronic hives, but treatment options such as antihistamines, corticosteroids, and other drugs can help manage symptoms.

Hives that come and go daily for at least 6 weeks are chronic hives. Most cases do not have an identifiable cause, but it is associated with an infection, autoimmune condition, allergy, or physical cause in some people.

Physical hives can occur due to exercise, vibration, or exposure to hot or cold temperatures. However, chronic idiopathic urticaria when there is no known cause is more common.

Chronic hives can affect a persons quality of life, but doctors can prescribe medications to help manage the symptoms.