Painful hives: what you should know

Hives are raised, often itchy patches or welts caused by temporary widening and leakage from small skin blood vessels. They may burn, feel tender or become painful when swollen. Individual welts can fade while new ones appear elsewhere. Deeper swelling of the lips, eyelids, tongue or throat is called Angioedema and can occur with hives. Triggers include infections, medicines, foods, heat, pressure and emotional stress, but a clear trigger is not always found.

Keep the skin cool and avoid hot showers, tight clothing, vigorous rubbing and pressure on affected areas. Use a cool compress and wear soft, loose fabrics. Record new medicines, foods, illness, exercise or exposures before the eruption, without stopping prescribed medicine unless a clinician advises it. A pharmacist or clinician can recommend an oral antihistamine and explain safe use. Oral corticosteroid treatment is reserved for selected situations and should be prescribed rather than self-started.

Call emergency services immediately for swelling of the tongue, lips or throat, trouble breathing, wheezing, faintness, confusion or difficulty swallowing. Seek prompt medical advice for painful hives with fever, bruising, blistering, skin peeling, joint pain or purple marks, or when individual lesions remain fixed rather than fading. A new medicine followed by widespread hives also needs urgent assessment.

Could a medicine, infection or physical trigger be contributing? Which antihistamine and dose are appropriate for me? How should I respond if facial swelling develops, and do I need specialist assessment for recurring episodes?