What Is Pressure Urticaria?

A Type of Hives Caused by Excessive Friction or Pressure

Urticaria; rash on arm
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Pressure urticaria is an uncommon type of hives (urticaria) caused when an excessive or persistent pressure is placed on the skin. This includes pressure exerted through friction, vibration, or the carrying of a heavy weight.

While a pressure rash may develop immediately upon the exertion of pressure, it will more often occur four to six hours after the pressure has been removed. The most common areas of rash are the hands, feet, trunk, buttocks, and legs.

Pressure urticaria is a chronic condition that usually starts in one's 20s and 30s and may persist for many years before spontaneously resolving. While it is not damaging to one's health per se, it can be extremely uncomfortable and interfere with both a person's sleep and quality of life.


While the exact mechanism of pressure urticaria is unknown, it is believed to be an autoimmune disorder in which the immune system responds to pressure in the same way it might an infection, namely by releasing a substance known as immunoglobulin E (IgE) into the bloodstream. Doing so triggers a reaction wherein mast cells (a type of defensive white blood cell) will begin to rupture and flood the body with histamine. Histamine is the chemical that triggers symptoms of allergy, including hives and rash.

Pressure urticaria may be further aggravated by heat, aspirin, or menstruation or is often experienced by persons with autoimmune disorders such as rheumatoid arthritis, lupus, or autoimmune thyroid disease.


Pressure urticaria is characterized by the development of raised, red weals that can be itchy, warm, and even a little painful. They tend to feel thicker and deeper than other forms of urticaria and may take up to 72 hours to resolve. Fever, headaches, fatigue, chills, and body aches may also accompany.

Pressure urticaria is typically constrained to the affected area of skin. It can be induced by standing on one's feet for too long, wearing tight clothing, sitting in one place, or leaning against a hard surface. Even prolonged clapping can cause a reaction.

Hives can often develop under a shoulder strap (such as from a purse or backpack) or a belt that has been cinched too tightly.


Pressure urticaria is diagnosed based on the appearance, location, and pattern of the rash. If an autoimmune disorder is suspected, a number of blood tests may also be ordered, including:

A pressure challenge can also be performed using a dermographometer, a pen-like instrument that can exert a pressure of 100 grams per cubic meter to the skin. Alternately, a weighted strap can be placed on the shoulder for 15 minutes and assessed six hours later to see if a rash or hive has developed.


There is currently no medical means to either prevent or eradicate pressure urticaria.

While oral antihistamines are frequently prescribed, their efficacy can vary significantly from one person to the next. Certain topical corticosteroids, such as clobetasol propionate, may be useful in reducing inflammation but can only be prescribed over short periods due to the risk of skin thinning (cutaneous atrophy), especially at higher strengths.

Doctors may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) if the swelling is accompanied by pain. Others have found that newer-generation asthma medications like Xolair (omalizumab) and Singulair (montelukast) can offer relief in certain cases.


From a lifestyle perspective, avoiding pressure urticaria may be easier said than done. It may help to wear loose-fitting clothes or to avoid standing or sitting on hard surfaces for long periods of time.

But, mostly, it's about being cognizant about the triggers that can lead to pressure hives. The more you are able to identify your personal triggers, the better able you will be to manage your condition over the long term.


Kasperrska-Zajac, A.; Jasinka, T.; Grzanka, A. et al. "Markers of systemic inflammation in delayed pressure urticaria."Int J Dermatol. 2013: 52(3):309. DOI: 10.1111/j.1365-4632.2011.05330.x.