Physical urticaria, also called physical hives, is a subgroup of general urticaria (hives). With physical urticaria, a physical stimulus results in a urticaria (hives) reaction. Common reactions may include small pinpoint hives, itching, wheals, flushing, and swelling.
This differs from general hives reactions, which may occur spontaneously with no connection to a known physical stimulus. Examples of physical stimuli include skin scraping, sun exposure, heat exposure, cold exposure, exercise, pressure/contact, anxiety/stress, and other physical methods.
Physical Urticaria Symptoms & Types
Physical urticaria types that are fairly common include the following:
- Dermatographic Urticaria (also called dermographic hives, or skin writing disease)-This type of hives is suggested to be the most common form of physical urticaria. Dermatographic urticaria is a hives reaction in response to scraping or stroking the skin with light force. In this type of hives, the skin will produce a wheal in the area where it is rubbed. It is called “skin writing disease” because individuals can write on their skin with their fingertips, and it will generally produce a wheal in the exact shape and location–similar to writing on the skin.
- Cholinergic Urticaria (also called heat hives)–This type of urticaria response to a heat stimulus, such as exercise, spicy foods, anxiety/emotions, etc. It can be induced by either passive or active heating of the core body temperature.
- Cold Urticaria (also called cold induced hives)–Cold urticaria develops in response to a cold object or temperature change. Similar to cholinergic urticaria, hives and/or itching may occur when the individual is subjected to cold environments. There is also a risk for swelling with this disorder.
- Solar Urticaria (also called solar hives)–Solar urticaria is a condition in which hives form in response to the sun or ultraviolet radiation. It can develop after sun exposure on both covered and uncovered skin sections.
- Pressure Urticaria–Pressure urticaria is a form of hives and wheals that develop in response to physical pressure (similar to dermatographia). Common triggers include wearing tight clothing or engaging in activity in which the skin is handled roughly. Delayed-pressure urticaria is a subset of pressure urticaria that develops hours after the initial contact rather than minutes.
- Aquagenic Urticaria (hives caused by water)–Aquagenic urticaria develops after exposure to a water stimulus. This can include bathing, swimming, sweating, and other forms of water. The hives can be very itchy, painful, and red. Patients can often tolerate drinking water, but may experience a hives reaction if it comes into contact with the outer layer of the skin.
- Papular Urticaria-Papular Urticaria is a type of hives that develops from common bug bites and skin irritations. These may include bed bugs, fleas, mosquitoes, and other similar pests.
- Contact Urticaria–Contact urticaria is a type of hives that develops due to a hypersensitive response to items that come into contact with the skin. This can include skin care products, latex, and common allergens.
- Stress Urticaria (hives)–This type of urticaria can result from severe stress and anxiety.
You can watch a video presentation discussing the different physical urticaria types:
Physical Urticaria Diagnosis
To diagnose a type of physical urticaria, doctors will generally perform a few simple tests. For example, with cholinergic urticaria, doctors may allow the patient to exercise or engage in an activity that causes passive or active heating to see if a hives reaction takes place. If you are suffering from any type of chronic urticaria (meaning hives lasting greater than 6 weeks), it is always a good idea to have a general checkup.
Allergy testing, skin pricks, and other tests may be useful as well for certain types of hives. For more information, click the specific type of hives on the navigation bar on this site.
Physical Urticaria Causes
In physical hives, it is often difficult to determine the exact cause. Many times, the cause is never determined, and the hives are called “idiopathic,” which means unknown. What researchers do know is that the hives themselves are caused by the mast cells leaking histamine into the surrounding tissues. This causes a reaction in the skin, which leads to itching, hives, flushing, burning, and other potential symptoms.
Physical Urticaria in Children
Physical urticaria can occur at any age, but most commonly appears in the late teens and early 20’s. It can be especially frustrating if children suffer from hives, as it can be difficult to pinpoint the exact type and the symptoms. Also, it may not be safe for children to take certain medications, which may otherwise be safe for an adult to take. Therefore, children should always see a dermatologist, allergist, or other doctor familiar with urticaria.
Physical Urticaria Treatment
Common treatments for physical urticaria include antihistamines. Antihistamines can help lessen symptoms by reducing itching, redness, and the formation of hives. In severe cases, stronger doses of antihistamines may be needed. Sometimes it can be more effective to combine H1 and H2 antihistamines. Always consult a doctor before ever taking a medication.
For some types of urticaria, it can be helpful to investigate or change dieting habits. Some individuals have reported improvement after eliminating common allergens such as preservatives, dairy, wheat, soy, nuts, and others.
Avoiding known triggers can also be helpful in minimizing discomfort and reactions. Here are some general treatments used in some urticarias:
- Mast Cell Stabilizers–Medications that help stabilize and strengthen mast cells can also be useful for some cases of urticaria.
- Water Filtration and Avoidance–Minimizing water contact on the skin is a way to avoid reactions. This includes wearing appropriate clothing to prevent sweating, brief showers, and more. In addition, using a water filter or water softener may help remove chemicals in the water.
- UV therapy–In some cases of urticaria, UV therapy has proven useful. This can be costly for some, and may include side effects of the skin such as increased skin cancer risks.
- Vitamins & Diet Modifications–For some urticaria conditions, it is also useful to remove any foods which increase allergic responses. Low histamine diets and restricted diets of known food sensitivities may be recommended. Avoiding common allergens such as wheat, dairy, eggs, and others may be useful. In addition, some individuals with urticaria may have low levels of vitamin d and other vitamins. Check with a doctor for a simple blood test that can determine any vitamin deficiencies.
- Hypoallergenic Products–It may also be useful to use hypoallergenic soaps, shampoos, detergents, and more. Also, avoiding external allergies (such as pollen, pet hair, dust mites, etc.) may help lessen symptoms.
For more advice on individual treatments, please visit the page for the type of physical urticaria you have.
Physical Urticaria Pictures (Images)
Pictures of urticaria often look similar, so it can be difficult to determine the exact type of hives by a picture alone. It is best to consult a doctor familiar with the different urticaria types to get a definite diagnosis. The pictures below indicate cholinergic urticaria and cold urticaria. For pictures on the other type of physical urticarias (including dermatographism, solar urticaria, and others), please visit their respective web page.