Urticaria or hives as it is commonly called, is an itchy rash consisting of localized swellings of the skin that usually last for a few hours before fading away. When urticaria develops around loose tissues of the eyes or lips, the affected area may swell excessively. Although frightening in appearance, the swelling (called angio-oedema) goes away in 12 to 24 hours with treatment.

Urticaria results from some changes in the small blood vessels of the skin. Such changes are brought about by the release of some substances in the body, the commonest of which is histamine. Histamine is released from cells called mast cells by either an allergic or non-allergic reaction.

Recurring attacks of urticaria may be caused by physical agents such as; sunlight, cold, pressure and sweat. Urticaria caused by such agents is called physical urticaria. The causative agent is usually recognized by the patient.
Chronic Urticaria
This is urticaria occurring almost daily and lasting more than two months. In the majority of patients, no cause or significant aggravating factors can be found. Physical urticaria may be present as well in some patients. Food allergy is seldom a cause of chronic persistent urticaria even though some foods may aggravate it. Infections such as candidiasis (a kind of yeast infection) may be a cause, although, not common.

Emotional stress is known to aggravate chronic urticaria in some. Fifty per cent of cases of chronic urticaria, clear spontaneously in about 6 months.

The best treatment for urticaria is to identify and avoid the cause and any aggravating factors. While investigating the cause, anti-histamines are prescribed for symptomatic relief. Antihistamines, when taken orally, take about 90 minutes to relieve an already formed hive. They work best if taken on a regular basic to prevent the formation of hives. To avoid side-effects like drowsiness, non-sedative antihistamines are available. Antihistamine creams are ineffective.

Elimination diets are not helpful unless a particular food is suspected. Skin tests are generally of no use. Blood and urine test are sometimes carried out to exclude infection as a cause of chronic urticaria.

Atopic dermatitis or eczema is an itchy, dry, hypersensitive skin disorder affecting many people. It is common in children but can occur at any age. It is not infectious or contagious.

The exact cause of atopic eczema is unknown. It may be hereditary. The patient or some family members may have other hypersensitive conditions like asthma or hay fever.

The rash may appear red, wet and weepy or dry, thickened and scaly. Scratching often aggravates the rash. The skin thickens and becomes darker. It is a chronic condition. It can affect any part of the body, particularly the elbow bends, back of the knees and the neck.

Since atopic dermatitis is sometimes associated with food allergies, can the elimination of certain foods be of help?
Yes, but it is uncommon. Although certain foods will sometime provoke attacks, especially in infants and young children, elimination of foods rarely brings about a lasting improvement or cure.

Nevertheless, when all else fails, avoidance of common offending foods such as cow's milk and eggs, may be tried for a few weeks.

Are the inhaled and contacted substances in the environment important causes, and should they be eliminated?
Yes. Dust and dust-forming objects (for example, feather pillows, kapok pillows and mattresses, dust-forming carpet, drapes, toys and certain rough garments such as wool, coarse silk) worsen the rash. Try to wet mop or vacuum floors, rather than sweep. Reduce contact with animal furs.

Are skin tests, as done in patients with hay fever or asthma, of value in finding the offending substances?
Yes, at times. However, results can be misleading particularly when the tests are carried out by persons inexperienced with such tests.

See your dermatologist. Try to relieve itching by eliminating these aggravating factors:

• rapid changes of temperatures, strenuous exercise and hot weather.
  
• rough, tight & woollen clothing.


• frequent use of soaps, bubble bath, hot water, and other cleansing procedures that tend to remove natural oil from the skin. Use mild detergents for your clothes and rinse the clothes thoroughly during washing.


• emotional upsets.

It is important to comply with treatment. Your dermatologist can usually help you by prescribing external remedies (corticosteroid creams are most effective). Use the creams sparingly. Do not use strong steroid creams for long periods as over-use will harm the skin. Use weak steroid creams when your eczema is mild. Oral medication (sedatives, antihistamines and sometimes, antibiotics by mouth) to control the itching and baths with diluted potassium permanganate are helpful. Corticosteroids taken by mouth or given by injections should be avoided if possible. However, when all other measures have failed, your physician may prescribe systemic corticosteroids for short periods.

Generally 90% of children outgrow the condition by early teens, although some continue to have problems even as adults.

Psoriasis is a chronic (long-lasting) skin disease of scaling and inflammation Although the disease occurs in all age groups, it primarily affects adults. It appears about equally in males and females. In its typical form, psoriasis results in patches of thick, red (inflamed) skin covered with silvery scales. These patches, which are sometimes referred to as plaques, usually itch or feel sore. They most often occur on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet, but they can occur on skin anywhere on the body. The disease may also affect the fingernails, the toenails, and the soft tissues of the genitals and inside the mouth.

Topical Treatments
Treatments applied directly to the skin may improve its condition. Doctors find that some patients respond well to ointment or cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or anthralin. Bath solutions and moisturizers may be soothing, but they are seldom strong enough to improve the condition of the skin. Therefore, they usually are combined with stronger remedies.

• Corticosteroids
• Calcipotriene
• Retinoid
• Coal tar
• Anthralin
• Salicylic acid
• Clobetasol propionate
• Bath solutions
• Moisturizers

A Guide to Psoriasis Triggers
Stress
Stress is a proven trigger in some people. It can cause psoriasis to flare for the first time or aggravate existing psoriasis.

Relaxation and stress reduction may help people with psoriasis. For example, not only does relaxation help lower stress levels, but also it gives people a feeling of control. These techniques, however, seem to work best with traditional medical treatments, instead of using the techniques alone.