Pressure Urticaria

About the Chronic Skin Condition

antihistamines in blister pack
Some antihistamines can help control chronic urticaria, but they rarely reduce pressure urticaria.. BSIP/Universal Images Group/Getty Images

Pressure urticaria is a type of chronic hives caused by physical stimulus, such as friction, vibration or pressure. The rash can appear immediately following pressure stimulus, though it more commonly occurs as delayed pressure urticaria after a 4 to 6 hour delay. The disease is chronic, lasting on average for 9 years, and it typically first appears during a person's 20s and 30s. It is not a life-threatening condition, but it can be very uncomfortable and can impact sleep and daily life.

Causes of Pressure Urticaria

The exact cause of delayed pressure urticaria is unknown, though it's thought to be an autoimmune disease. Mast cells play an integral role in the development of this skin condition. They contain chemicals such as histamine that cause hives to form.

Certain parts of the body that have more exposure to pressure stimuli are more prone to developing pressure urticaria. Common pressure stimuli include the following:

  • Wearing tight clothing (waistbands, socks, shoes, bra straps, belts, cuffs, watches)
  • Sitting, standing or walking on a hard surface
  • Working with your hands
  • Clapping your hands
  • Carrying a purse
  • Kissing
  • Sexual intercourse
  • Using a tampon

Symptoms & Appearance of Pressure Urticaria

Pressure urticaria is characterized by lesions that are red, raised, swollen and often itchy. These lesions most commonly appear on the hands, feet, trunk, buttocks, legs and face, and they can last anywhere from 8 hours to 3 days.

The hives of pressure urticaria are deeper and more painful than hives caused by other stimuli. Fever, malaise, fatigue, chills, headaches and body aches may also occur.

Diagnosing Pressure Urticaria

Pressure urticaria is diagnosed based on the appearance of the rash in areas where pressure has been applied to the skin.

Additionally, your doctor might ask you to track your daily activities, what medications and supplements you take, where the hives appear and how long it takes for them to fade. Lab tests are uncommon, but they might be necessary if your body doesn't respond to treatment.

Pressure Urticaria Treatment & Prevention

Medically, there is no guaranteed way to completely eradicate pressure urticaria. Some patients are able to find relief with antihistamines and anti-itch medications, but efficacy varies. Some antihistamines can help control chronic urticaria, but they rarely reduce pressure urticaria. Oftentimes clobetasol propionate, a topical corticosteroid, is prescribed to reduce inflammation, but regular use of the product can cause skin thinning. There are less abrasive topical corticosteroids available, but they aren't very effective.

Many patients rely on oral corticosteroids to control symptoms, which are generally hit-or-miss. Systemic corticosteroids have historically produced inconsistent results, and they're also associated with several adverse side effects.

Other options include prescribed NSAIDs, such as colchicine, dapsone, sulfasalazine and montelukast.

Pressure urticaria can be a debilitating disease, especially because it's chronic. Trying to prevent a rash from forming is difficult because pressure stimuli are nearly impossible to avoid. Opt to wear more loosely fitting clothing and try not to sit or stand on hard surfaces for prolonged periods of time. You may also want to keep a journal to track the what, when and where of your hives to help your doctor more accurately identify the triggers.

Sources:

Beggs, S. (2014, September 09). Pressure Urticaria. Retrieved March 25, 2016, from http://emedicine.medscape.com/article/1050387-overview#showall

Duffill, M. (2013, December 29). Pressure urticaria. Retrieved March 25, 2016, from http://www.dermnetnz.org/reactions/pressure-urticaria.html

Grattan, Clive and Anne Kobza Black. "Urticaria and Angioedema." Dermatology. 2nd. Ed. Jean Bolognia. New York: Mosby, 2008: 261-76.

Guldbakke, KK, and A Khachemoune. “Etiology, classification, and treatment of urticaria.” Cutis. 79(2007): 41-9.

Habif, Thomas. "Urticaria and Angioedema." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 129-61.

Mayo Clinic Staff. Chronic hives (urticaria). (n.d.). Retrieved March 25, 2016, from http://www.mayoclinic.org/diseases-conditions/chronic-hives/basics/definition/con-20031634

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