What Is Chronic Spontaneous Urticaria? Dermatologists Explain

This informational guide, part of PS's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Dealing with hives in any situation isn't ideal, but they usually clear up quickly for most people. In some cases, though, the breakouts are long-lasting and can be downright debilitating. Take chronic spontaneous urticaria (CSU), for example. When you have CSU, it means dealing with hives that last for six weeks or more.

The condition can be life-altering for people who struggle with it, but treatments are available — it just may take time to get a proper diagnosis. The condition is frequently misdiagnosed as allergies. Knowing how to spot the signs can be crucial when it comes to finding treatment. Below, dermatologists explain what chronic spontaneous urticaria involves, symptoms to look out for, and how to get relief.

Experts Featured in This Article:

Joshua Zeichner, MD, is the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital.

Gary Goldenberg, MD, is a board-certified dermatologist practicing in New York City.

What Is Chronic Spontaneous Urticaria?

Chronic spontaneous urticaria is an inflammatory skin disease that causes hives that last for at least six weeks, according to Joshua Zeichner, MD, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital.

"These hives can be present every day or most days," says Gary Goldenberg, MD, a board-certified dermatologist practicing in New York City.

Chronic spontaneous urticaria causes red, swollen welts on the skin, Dr. Zeichner explains. "They can occur anywhere on the body and range in severity from a single spot to covering large areas of skin," he says. They may also appear differently on different skin tones, as hives on darker skin can still appear raised, but may not be red in color.

While a lesser-known condition, research shows that one percent of the world's population is impacted by CSU, including three million people in the US. People with chronic spontaneous urticaria are more likely than the general population to have other health conditions, including thyroid gland disorders, anxiety, depression, and a metabolic syndrome like type 2 diabetes.

Chronic Spontaneous Urticaria Symptoms

Symptoms of chronic spontaneous urticaria can vary by person, but Dr. Goldenberg says they generally include the following:

• Hives that last for at least six weeks
• Intense bouts of itching
• Skin burning
• Feeling hot
• Flushing
• Swollen skin

"These breakouts are unpredictable and can occur anytime, with seemingly no stimulation," Dr. Goldenberg says.

What Causes Chronic Spontaneous Urticaria?

The tricky thing with chronic spontaneous urticaria is that the cause of the hives is unknown, according to the American College of Allergy, Asthma and Immunology (ACAAI). Some cases may be linked with an autoimmune disorder, while others may be associated with thyroid disease or a hormonal issue, the organization says.

"We don't understand why it happens, but we know it is driven by over-activation of allergic blood cells that release histamine and cause blood vessels to dilate and become leaky," Dr. Zeichner says.

How Is Chronic Spontaneous Urticaria Diagnosed?

A diagnosis usually involves an evaluation with a dermatologist or allergist. That may include having bloodwork to check for and rule out certain allergies, Dr. Goldenberg says. "In some instances, a skin biopsy can be helpful to rule out other conditions that may mimic hives," he adds.

Chronic Spontaneous Urticaria Treatment

There are several treatment options available for patients. "First-line treatment is with antihistamines such as Benadryl," Dr. Goldenberg says.

But injectable biologic medications are also "highly effective," he says. Those include omalizumab, although the medication doesn't effectively treat at least 30 percent of patients. Research shows that cyclosporine, which is an immunosuppressive medication, can also be used off-label and can improve symptoms in up to 73 percent of patients. Ultimately, you can discuss these options with your provider.

Both experts agree that if you think you have CSU and you're dealing with chronic hives, it's important to see a doctor sooner rather than later for evaluation and treatment options. "As this is a chronic condition, there is no cure," Dr. Goldenberg says.

Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.

Image Source: Photo Illustration by Keila Gonzalez