Signs and Symptoms of Hives (Urticaria)

Hives is a common inflammatory skin condition characterized by the formation of bumps on the skin (called wheals) and sometimes accompanied by areas of swelling (angioedema). Hives is clinically known as urticaria. The individual bumps that occur with hives grow within minutes to hours and resolve within 24 hours without leaving any permanent marks. While most cases are acute and resolve on their own within six weeks, others, known as chronic spontaneous urticaria, persist longer.

Alongside the characteristic bumps, itchiness (called pruritis) and skin sensitivity are the primary symptoms of hives. Any part of the body can be affected, with symptoms typically worsening at night and disrupting sleep. The angioedema that may accompany hives arises as swelling in the face, lips, limbs, or genitals.

It’s important to understand how hives manifest on the body and recognize when it is a sign of something serious. This article provides a quick overview of the symptoms of this condition as well as when it’s time to seek medical help.

Wheals

The primary manifestation of hives is the development of characteristic bumps on the skin, known as wheals. In a majority of hives cases, the issue is acute and goes away on its own within one week. However, a subset of patients has chronic urticaria and experience recurrent flares of symptoms for six or more weeks.

Wheals have several qualities:

• Onset: Wheals set on relatively quickly, within minutes to hours. Individual wheals may combine with others. While bruising or scabbing can result from stratching, they do not leave a mark. They tend to resolve within 24 hours.
• Size and shape: Typical wheals are round, oval, or irregular in shape, ranging in size from less than one to several centimeters (cm).
• Color: The wheals have a distinct reddish or darker color. When pressed, the elevated bump may temporarily lighten, a phenomenon known as “blanching.”
• Location: While wheals can affect any part of the skin, they can be more severe or prominent on parts of the skin that are exposed to increased pressure from clothing, such as at a waistband. In addition, areas where skin rubs on skin are more prone to flares.   
• Itchiness: While the wheals aren’t painful to the touch, they are very itchy. This itchiness is often worse at night.

Swelling

In about 40% of hives cases, the wheals are accompanied by broader areas of swelling and inflammation, or angioedema. This is most often seen affecting the lips, face, area around the eyes, limbs, and genitals, causing sensitivity, slight pain, tingling, or numbness. Typically, it takes several minutes to hours for angioedema to arise, with the issue lasting anywhere from one to three days before resolving.

Systemic Symptoms

In rarer cases of chronic spontaneous urticaria—a chronic form of hives, in which symptoms persist longer than six weeks—people experience some additional, systemic symptoms. These include:

• Headache
• Fatigue
• Pain or swelling of the joints
• Wheezing
• Flushed skin
• Gastrointestinal symptoms, such as nausea, vomiting, and abdominal ache
• Heart palpitations (irregular heartbeat)

Notably, some of these symptoms may also imply a more serious underlying condition. Signs prompting further evaluation and testing include fever, painful wheals, bumps lasting longer than 48 hours, or changes in skin color or bruising after the wheals go away.

Quality of Life Impacts

While hives is rarely a sign of a dangerous or fatal condition, it can significantly impact your quality of life and daily functioning. Since the associated itchiness tends to be worse at night, you may often experience difficulty getting enough restful sleep. Persistent discomfort can also make work or being in school difficult.

When to See a Healthcare Provider

A vast majority of hives cases are acute and resolve on their own without the need for medical treatment. However, certain signs prompt a trip to your healthcare provider. These include:

• Hives lasting more than a few days
• Wheals and/or angioedema are widespread
• Symptoms arise due to a specific trigger or medication

A Quick Review

Hives, also known as urticaria, is an inflammatory skin condition that causes itchy red bumps to form on the skin, sometimes accompanied by broader regions of swelling. The bumps, known as wheals, range in size from less than one to a couple of centimeters and tend to resolve within 24 hours. 

While most cases of hives resolve on their own without medical management, some become chronic, going through periods of flaring up and receding. Swelling in the mouth or throat, breathing difficulties, or feeling faint alongside hives are signs of a medical emergency.