⚕️ FREE MSRA PODCAST – Urticaria (Hives)
🎧 A high-yield breakdown of this itchy, wheal-forming skin condition – crucial for exams and everyday clinical practice.

🧠 Key Learning Points

📌 Definition
• Urticaria (hives) is a transient, pruritic skin eruption characterised by raised, red or pale wheals that resolve within 24 hours.
• Angioedema may accompany it and involves deeper skin swelling.

📌 Causes & Risk Factors
• Allergic triggers – food, medications, insect stings
• Non-allergic – cold, heat, pressure, sunlight, vibration, stress
• Infections (especially viral), autoimmune diseases (e.g. thyroid)
• Chronic idiopathic urticaria – no identifiable cause
💡 Mnemonic: "PHYSICAL" – Pressure, Heat, Infection, Cold, Idiopathic, Autoimmune, Latex/drugs

📌 Pathophysiology
• Mast cell degranulation → histamine release
• Histamine → vasodilation + increased capillary permeability
• Results in fluid leakage → wheals + intense itching
• Angioedema = same process, but deeper tissues affected

📌 Symptoms
• Sudden onset of raised, itchy wheals (pink/red) with pale centres
• Lesions last <24 hours and move around
• Angioedema: deeper swelling of lips, eyelids, genitals
• Chronic urticaria: symptoms ≥6 weeks

📌 Differential Diagnosis
• Urticarial vasculitis (painful, persistent >24h, bruising)
• Dermatitis herpetiformis (coeliac-related itchy blisters)
• Eczema (dry, scaly, fixed)
• Bullous pemphigoid
• Polymorphic eruption of pregnancy
• Mastocytosis (urticaria pigmentosa)

📌 Diagnosis
• Primarily clinical – based on transient wheals + history
• Investigations guided by clinical suspicion
• Skin prick or IgE tests for suspected allergy
• Challenge tests for inducible types (e.g. ice for cold urticaria)
• Biopsy only if urticarial vasculitis suspected

📌 Management
• Identify and avoid triggers (physical, food, drugs, etc.)
• First-line: non-sedating H1 antihistamines (e.g. cetirizine, loratadine)
• Increase dose up to 4x for chronic urticaria if needed
• Short course of oral steroids for acute severe flares
• Second-line: montelukast, omalizumab (anti-IgE), or immunosuppressants in refractory cases
• Educate on avoidance of exacerbating factors: stress, alcohol, NSAIDs

📌 Complications
• Angioedema (esp. lips, eyelids, airway)
• Anaphylaxis in allergic urticaria – medical emergency
• Chronic symptoms → sleep disturbance, anxiety, depression

📌 Prognosis
• Acute urticaria usually self-limiting (resolves in days)
• Chronic urticaria: ~50% resolve within 3–5 years
• Persistent symptoms in ~20% after 10 years
• Poorer prognosis if associated with angioedema or autoimmune markers (e.g. antithyroid antibodies)

📎 More MSRA Resources for Urticaria
📝 Revision Notes: https://www.passthemsra.com/topic/urticaria-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/urticaria-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/urticaria-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/urticaria-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/

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