Urticaria Unpacked: Diagnosis, Labs, and Treatment at a Glance

Welcome back, DERM Community!

Last week, we zoomed in on nail beds and battled fungi in our deep dive on Onychomycosis.
Did you miss the yellow, brittle clues? Head to our archive to catch up.

This week on Beneath the Surface, we’re trading nails for welts and wheels.
Let’s talk urticaria: a deceptively simple rash that hides a complex web of triggers, timelines, and systemic clues.

You’ve seen it: red, itchy welts that rise and vanish, sometimes within hours.
Sometimes it’s allergy.
Sometimes it’s autoimmune.
Sometimes it’s… unexplained.
Always, it’s a chance to dig deeper.

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Learning Opportunities:

Raised, pruritic, transient wheals, sounds easy to diagnose, right?
And yet, urticaria often masquerades as drug reactions, viral rashes, or contact dermatitis.

This week, we’re unpacking:

• The different faces of urticaria

• The myths about antihistamines

• When to investigate systemic disease

• How to manage patient expectations when there's no clear trigger

What is Urticaria?

It is a vascular skin reaction characterized by transient, edematous, erythematous plaques, often intensely itchy.

Lesions typically last <24 hours and resolve without post-inflammatory changes.

It may be isolated or part of a broader allergic or autoimmune process. Chronic urticaria is defined by symptoms lasting more than 6 weeks.

While acute urticaria often resolves within days and is usually triggered by infection, food, or medications, chronic urticaria is a different beast. 

For many patients, the cause remains idiopathic, though autoimmune mechanisms are increasingly recognized. 

The unpredictable flare-ups, impact on sleep, and emotional toll make chronic urticaria more than a skin issue; it’s a quality-of-life disruptor that demands thoughtful, long-term management.

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👋🏻 See you next Thursday, DERM community!

Thanks for joining us on Beneath the Surface.

Urticaria may come and go, but for patients, it’s a chronic source of anxiety, frustration, and missed diagnoses.

Our job? Spot patterns, know when to investigate, and treat the person, not just the rash.

If today’s pearls helped clear up the mystery of hives, share them with your peers, students, or allergy friends.

— The Derm for Primary Care Team