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Conditions We Treat

Urticaria

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

What is Urticaria?

Urticaria, or more commonly known as hives, is a skin condition where raised and itchy welts appear suddenly on the skin. These welts can vary in size and shape, merging into larger patches or shifting from one area to another.

While most hives fade within hours, recurrent or persistent urticaria can be frustrating and impact daily comfort. Although the condition is usually not dangerous, it can sometimes signal underlying allergies or immune reactions that need attention.

urticaria Singapore
Urticaria is characterised by raised and itchy bumps, which occur when the body releases histamine and other chemicals into the nearby tissues.

What are the types of Urticaria?

The skin condition can be classified based on its duration and triggers. These include:

  • Acute urticaria – hives that last less than 6 weeks, often caused by infections, medications or food allergies.
  • Chronic urticaria – hives that persist or recur for more than 6 weeks, sometimes without an identifiable cause.
  • Physical urticaria – hives triggered by physical stimuli such as cold, heat, pressure, vibration or sunlight.
  • Dermographism – a type of urticaria where the skin develops raised welts when scratched or rubbed.

What causes Urticaria?

Urticaria develops when certain immune cells in the skin, called mast cells, release histamine and other inflammatory chemicals into the surrounding tissue. This release causes the small blood vessels in the skin to widen and leak fluid, leading to raised, itchy welts known as hives.

In some people, this reaction is triggered by allergens such as food or medication, which the immune system mistakenly identifies as harmful. In others, the mast cells become overly sensitive and release histamine without any clear threat. This is often the case in chronic urticaria.

The underlying mechanism always involves this overactivation of mast cells, which explains the sudden onset of redness, swelling and itchiness.

What are the potential triggers of Urticaria?

While the biological mechanism behind urticaria is the same, what sparks mast cells to release histamine can vary widely from person to person. The triggers can generally be grouped into:

  • Common foods such as shellfish, nuts, eggs, milk and certain additives.
  • Medications like antibiotics, aspirin, ibuprofen or blood pressure drugs.
  • Viral infections, such as cold, flu, hepatitis.
  • Bacterial infections, such as urinary tract or throat infections.
  • Parasitic infections in some cases.
  • Heat, cold, sunlight or water exposure.
  • Pressure or vibration on the skin, like tight clothing, straps, or repetitive rubbing.
  • Temperature changes, such as moving from air-conditioning into hot, humid weather.
  • Stress, anxiety or hormonal changes.
  • Contact with dust mites, pet dander or pollen.
  • Alcohol or spicy foods that dilate blood vessels and worsen hives.
urticaria triggers.
Urticaria are often triggered by common allergens like shellfish, dust mites or a temperature change.

What are the characteristics of Urticaria?

Although hives may look alarming, their features follow a recognisable pattern that helps with diagnosis. Urticaria is marked by:

  • Raised welts – pink, red or skin-coloured bumps that vary in size from small dots to large patches.
  • Itchy or burning sensation – itchiness is the most common symptom, though some patients describe a stinging feeling.
  • Changing and moving – welts may appear in one area, fade within hours, then reappear in a different spot.
  • Short-lived individual lesions – each hive typically lasts less than 24 hours, even without treatment.
  • Angioedema – in some cases, deeper swelling affects the lips, eyelids or hands, creating a puffy appearance.

This fleeting and migratory nature of hives is one of the key features that separates urticaria from other rashes.

Who is at risk of Urticaria?

Urticaria can affect anyone, but certain groups are more likely to experience it because of how specific factors interact with the skin and immune system. This includes:

  • Gender – chronic urticaria is observed more commonly in women, possibly due to hormonal influences on the immune system.
  • Family history of urticaria or allergies – genetics play a role in how sensitive your mast cells are. Having close relatives with urticaria or allergic conditions makes you more susceptible.
  • Allergies – if you already have allergic conditions like asthma, allergic rhinitis or eczema, your immune system is more prone to exaggerated responses, increasing the chance of hives.
  • Frequent infections – viral or bacterial infections often act as a spark for urticaria, especially in children. A weakened or overactive immune system increases the likelihood of flare-ups.
  • Environmental irritants – living in cities like Singapore, with high humidity, air pollution and dust mites, can challenge sensitive skin and provoke more frequent hives.
  • Stress – emotional and physical stress can stimulate chemical pathways that make mast cells more reactive, worsening or triggering urticaria.
risk of urticaria in Singapore
People with a family history of urticaria or allergies have an increased risk of experiencing urticaria too.

How is Urticaria diagnosed in Singapore?

Hives can be tricky to pin down because they often come and go within hours. At Livingstone Dermatology, our approach to diagnosis is with careful questioning and tailored assessments to uncover the possible root causes. This entails:

  • History of flare-ups – our dermatologists start by discussing when the hives appear, how long each episode lasts and whether they follow a particular pattern. For example, do they occur after meals, with certain medications or during times of stress?
  • Impact on daily life – beyond just the rash, our dermatologists ask about how the itching or swelling affects your sleep, work or comfort, as this helps guide treatment urgency.
  • Skin review – if hives are visible during your visit, our dermatologists will observe their appearance, size and distribution. When welts are absent, photos or descriptions from the patient are very helpful.
  • Trigger exploration – our dermatologists will look into lifestyle details such as diet, exercise, travel, skincare products and work exposures, as even small details can reveal hidden links.
  • Allergy investigations – depending on the history, tests such as skin prick testing or blood tests may be used to check for allergies to food, medication or environmental factors.
  • Special challenge tests – when physical urticaria is suspected, safe in-clinic tests, such as applying pressure or cold to the skin, may be carried out to confirm the trigger.
  • Further blood work – in cases of chronic or persistent urticaria, additional tests may be recommended to rule out autoimmune, thyroid or infection-related causes.

How is Urticaria treated in Singapore?

Managing urticaria focuses on reducing symptoms, preventing flare-ups and addressing underlying triggers. Our dermatologists usually group treatment measures into supportive care, medication and modern therapies.

Some of the treatment measures include:

  • Avoidance of triggers – identifying and limiting exposure to foods, medications or environmental factors that provoke hives.
  • Gentle skincare – using mild cleansers, avoiding hot showers and wearing loose, breathable clothing to reduce irritation.
  • Soothing measures – cool compresses, moisturisers and anti-itch lotions to calm the skin.
  • Stress management – relaxation techniques and lifestyle changes, as stress is a known aggravator for some patients.
  • Non-sedating antihistamines – the cornerstone of treatment, taken daily or as needed to reduce itch and swelling.
  • Dose adjustments – in chronic cases, higher doses or combinations of antihistamines may be prescribed for better control.
  • Short courses of corticosteroids – sometimes used for severe flare-ups, but not suitable for long-term use.
  • Biologic therapy (omalizumab) – targeted injections for chronic urticaria that does not respond to antihistamines. These work by calming overactive immune cells.
  • Immunomodulatory medications – in resistant cases, drugs such as cyclosporine may be considered under careful monitoring.
  • Combination therapy – integrating antihistamines, biologics and supportive care to achieve stable, long-term control.
treatment for urticaria
Aside from lifestyle adjustments, our dermatologist may prescribe an antihistamine to manage urticaria flare-ups.

Summary

Although urticaria can feel unsettling because of its sudden flare-ups, it is a condition that can be managed effectively with the right care. Many patients find relief once their triggers are identified and a personalised treatment plan is in place. With modern therapies available, even persistent hives can be controlled to restore comfort and confidence.

If you are experiencing recurrent hives or unexplained skin swelling, know that help is available. At Livingstone Dermatology, we work with you to understand your condition, ease your symptoms and guide you towards long-term relief. Book a consultation with us today to receive effective care with a treatment plan tailored to your unique condition.

Frequently Asked Questions

Is urticaria the same as hives?

Yes. Urticaria is the medical term for hives, which are raised, itchy welts that appear on the skin.

Stress does not directly cause urticaria, but it can make mast cells more reactive, worsening existing hives or triggering flare-ups in sensitive individuals.

Acute urticaria usually clears within days to weeks, while chronic urticaria lasts longer than 6 weeks and may continue for months or even years. With proper management, symptoms can be controlled effectively.

No. Urticaria is not an infection, so it cannot spread from one person to another.

Yes. Foods such as shellfish, nuts, eggs and milk are common triggers, especially in children. However, not all urticaria is caused by food, so testing may be needed before making dietary changes.

Yes. Urticaria is common in children, often linked to viral infections or food triggers. The good news is that most cases are short-lived and resolve with treatment.

For long-lasting urticaria, daily non-sedating antihistamines are usually the first step. If symptoms remain uncontrolled, advanced options such as biologic injections or other specialist treatments may be recommended.

You should seek medical advice if your hives are recurrent, interfere with sleep or daily life or last longer than a few weeks. Urgent care is needed if hives occur with swelling of the lips, tongue or throat, or if you experience difficulty breathing.

Acute urticaria often resolves once the trigger is removed. Chronic urticaria may not always have a clear cause, but with treatment, symptoms can usually be well controlled, and many patients see the condition improve over time.

Yes. Wearing loose clothing, avoiding known triggers, keeping cool in Singapore’s humid weather and practising stress management can all help reduce flare-ups.

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