When hives keep coming back for no obvious reason

Chronic spontaneous urticaria (CSU) is a puzzling skin condition that causes recurring itchy, raised hives for more than six weeks without an obvious trigger. Dermatologist Dr Peter Ch’ng explains that the rash can appear suddenly, fade within hours, then emerge elsewhere, making it difficult to predict. Many patients mistake CSU for eczema, psoriasis, or allergic reactions.

The condition can significantly impact a person's life, causing sleep disturbances, concentration issues, and affecting work and social activities. A Malaysian study revealed that over 80% of CSU patients reported moderate-to-severe itching and hives, which interfered with their daily lives. Photographs of the rash can be helpful for diagnosis, detailing its appearance and behavior.

CSU requires a broader treatment approach beyond just treating each new episode. Typical urticaria lesions are smooth and transient, disappearing within a day, while persistent rashes may indicate another condition. Repeated applications of steroid cream to new hives are generally ineffective, as the rash quickly moves to different areas. Systemic steroid injections should also be avoided long-term due to potential health risks.

First-line treatment typically involves second-generation H1 antihistamines, with escalating treatment as needed. The goal is to achieve clear, symptom-free skin, not just a partial improvement.