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Chronic spontaneous urticaria (CSU) is responsible for 80% of all cases of chronic hives, but 90% of people never know what causes it.

"A lot of times, patients want to know if something they're doing is causing the hives," said Jenny Murase, MD, of the University of California, San Francisco, and director of Medical Dermatology Consultative Services and Patch Testing for the Palo Alto Foundation Medical Group. "I think it's helpful to talk about the relapsing and remitting nature of hives to help patients understand when it's not necessarily related to something they're doing."

Chronic hives affect people of all ages worldwide, but are seen most often in women between the ages of 20 and 40. Characterized by extremely itchy red or flesh-toned bumps and welts on the skin, these longer-lasting hives come and go in a random pattern for 6 weeks or longer -- sometimes years.

About 40% of people with chronic hives also have swelling in the deeper tissues of the skin of the face (eyes and lips), neck, and hands and feet -- a condition known as angioedema.

Hives can have a huge impact on quality of life. Some people become self-conscious about their skin and withdraw socially, for instance. "Chronic spontaneous urticaria is physically disfiguring when involving areas not covered by clothing, and is often totally unpredictable," noted Chris G. Adigun, MD, of the Dermatology and Laser Center of Chapel Hill in North Carolina.

Hives can also destroy sleep, affecting performance at work and at school. Alison Ehrlich, MD, of Foxhall Dermatology and Research Center in Washington, D.C., remembers losing three nights of sleep in a row: "If you're covered in hives, you're pretty miserable," she said. "You can't sleep, and you're exhausted."

Studies show that more than one-third of people with CSU have symptoms of anxiety and depression, and CSU can affect sexual function, particularly those who also have angioedema.

More positively, chronic inducible urticaria (CIndU), which makes up the remaining 20% of chronic urticaria cases, is caused by exposure to specific environmental triggers that can be identified and avoided -- such as heat, cold air, cold water, ultraviolet light, vibration, exercise, and pressure on the skin.

Even when the cause of chronic hives can't be identified, however, there are treatments that can help control symptoms in both types of chronic urticaria (and some 20% of people with CSU also have CIndU).

Your doctor will typically recommend starting with a non-sedating H1-antihistamine to reduce symptoms of itch and angioedema and decrease the risk of recurring hives. If symptoms don't respond to antihistamines, omalizumab (Xolair), an injectable prescription medication, has helped control symptoms in individuals ages 12 and older.

There are other treatment options, too, including the use of corticosteroids for a short period of time and medications such as cyclosporine.

Self-care is also important: Try very hard not to scratch, since scratching puts the itch into overdrive, and increases the risk of infection by creating microscopic tears in the skin that allow bacteria to get into the bloodstream.

Instead, soothe itch by bathing in lukewarm (not hot) water sprinkled with either baking soda, uncooked oatmeal, or colloidal oatmeal. (Similarly for taking a shower: Keep the water lukewarm or cool.)

Use only fragrance-free soaps and cleansers, and don't rub affected skin with a towel. Instead, let your skin air-dry, and then apply a thin layer of an over-the-counter anti-itch lotion or cream.

Finally, wear loose-fitting clothing made of smooth, natural fabrics such as 100% cotton, and avoid scratchy materials such as wool or non-breathable synthetics.

Additional Resources:

Read previous installments in this series:

For Your Patients: All About Hives

For Your Patients: Understanding the Many Different Types of Hives

For Your Patients: How Will My Doctor Diagnose Hives?

For Your Patients: What's the Best Treatment for Hives?

For Your Patients: Is Stress Causing My Hives?

For Your Patients: Is It Safe to Treat Hives During Pregnancy?

For Your Patients: Help! My Child Has Hives

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.