Urticaria – Clinical patterns and profile
Appearance of the skin. Urticaria typically involves a strongly changed skin appearance, which patients often describe as follows: "Last night my skin was completely normal, this morning it looked like a piece of coffee cake and I could barely stand the itchiness, but by the time I saw the doctor late in the morning, it was completely gone." Wheals are the element most commonly observed during an episode, but flaring and angioedema (deep skin swelling) are also not uncommon. Roughly half of patients with urticaria end up with both wheals and angioedema. Of the remainder, some 40% of patients with urticaria only experience wheals, while approx. 10% suffer only angioedema. It's not yet known why urticaria last longer and often takes a more difficult course for those patients who also develop angioedemas.
Symptoms. Above all, the disease brings with it an unbearable itchiness that seems like a torture to many patients. Think about how difficult it is to concentrate on daily life after coming in contact with stinging nettles or getting bitten by a mosquito–and that itch only lasts for a little while! In contrast, urticaria patients often face wheals on their entire bodies, and not just once, but several times a day, over the course of months, years, even decades.
Even worse, the human body is capable of adapting to external stimulants such as heat or pressure, but struggles to do the same with itchiness. The itchiness involved in hives also lures us to rub, not scratch (unlike the itchiness associated with neurodermatitis), e.g. skin scratched by fingernails is rare. Quite the contrary, it is often reported that the itchy spots of the skin have to be "rubbed at" with the fingertips for a long time. The affected spots are almost always perceived as hot and – once the episode dies down – as being dry. Patients periodically also speak of a burning of the skin, less frequently about real pain in the afflicted spots.
Additional symptoms. Many patients complain of headaches or joint pain during an episode of urticaria. The first thing to determined is whether the wheals, itchiness and swelling are the result of pain treatment and were triggered through the ingestion of acetylsalicylic acid (such as in Aspirin®) or other chemically related drugs (many drugs are known to induce urticaria, see the section on "Acute Urticaria"). Patients suffering from urticaria should refrain from taking acetylsalicylic acid, and instead choose pain relief drugs known for having fewer side effects, such as acetaminophen (Paracetamol, Tylenol, etc).
Yet pain may also indicate an infection: it's been established that chronic infections, i.e. those that exist over a lengthier period, can trigger, support and worsen urticaria. For whatever the reason, pain frequently arises in association with urticarial episodes, even if there is no explanation of how. One possible explanation may be the high amounts of histamine that are released during urticaria episodes.