What Is Pressure Urticaria?

Everything You Need to Know 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 that's caused by a physical stimulus, such as friction, vibration, or pressure. The rash can appear immediately following a pressure stimulus, though it more commonly occurs as delayed pressure urticaria after a four- to six-hour delay. The disease is chronic, lasting, on average, nine years, and it typically first appears during a person's 20s and 30s.

(To be clear: The hives don't last for nine years, but they can appear on and off in a recurring fashion.It is not a life-threatening condition, but it can be very uncomfortable and can negatively affect sleep and daily activities.

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

    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 eight hours to three days. The hives of pressure urticaria are deeper and more painful than hives that are caused by other stimuli.

     Fever, malaise, fatigue, chills, headaches, and body aches may also occur.

    Diagnosing the Condition

    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. Often, 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.

    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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