A kind of chronic urticaria known as pressure urticaria is characterized by recurrent hives brought on by pressure applied to the skin. Medication and trigger avoidance may be used in tandem to treat it.

Urticaria, the medical term for a rash with welts that is usually itchy, is more commonly known as “hives.” The majority of urticaria cases start suddenly and are acute. Rashes brought on by viral infections or allergies are two examples.

Chronic urticaria is less common. One type of chronic urticaria, also known as chronic inducible urticaria, or CIndU for short, is pressure urticaria. Pressure on your skin, such as from backpack straps or extended sitting or standing, can cause the condition.

Similar to other forms of CIndU, pressure urticaria can cause swelling and hives that persist for more than six weeks.

The symptoms, causes, diagnosis, and management of pressure urticaria are examined in greater detail in this article.

What are the symptoms of pressure urticaria?

Itchy hives from pressure urticaria can persist for almost six weeks at a time. When your skin comes into contact with an outside pressure, the hives first appear. Within five minutes after the first pressure or trigger, symptoms typically appear.

Usually the same color as your normal skin tone, the hives can occasionally be a shade of pinker or redder. Although they are typically round, they can change into rings, big patches, or even outlines that resemble maps.

Angioedema, or extreme swelling in the deep tissues of the skin, can accompany hives from pressure urticaria.

Angioedema frequently affects the skin’s deep tissues and mucous membranes. The primary worry is that breathing may become difficult or impossible due to excessive airway edema.

Angioedema is more likely to appear on your body than hives, which can appear anywhere on your body.

• hands
• feet
• face
• genitalia

The duration of pressure urticaria symptoms might range from 8 to 72 hours.

Delayed and immediate pressure urticaria

Additionally, this illness has two subtypes: acute pressure urticaria and delayed pressure urticaria.

• Compared to immediate pressure urticaria, delayed pressure urticaria is thought to be more prevalent. About four to six hours after the first skin contact, this subtype results in hives.
• Immediate pressure urticaria, as the name implies, results in hives practically instantly upon touch.

What are the potential triggers or causes of pressure urticaria?

The following are typical causes of pressure urticaria:

• Physically demanding jobs that require extended standing or walking, sitting on something (like a car seat or a horse) for extended periods of time, carrying a heavy bag on your shoulders or by hand, standing on something that digs into your feet, like a ladder rung, wearing tight clothing that rubs against your skin, or anything else that is pressed against your skin for extended periods of time

Potential risk factors

Menstruation, heat, or aspirin use can sometimes make the symptoms of pressure urticaria worse.

Additionally, there may be an autoimmune component to persistent urticaria. In these situations, your body might create autoantibodies that target immune cells that are normally healthy.

Compared to CIndU kinds, where the triggers are recognized, chronic spontaneous (idiopathic) urticaria is believed to have a higher prevalence of the autoimmune link. The latter category includes pressure urticaria.

Nevertheless, some experts believe that mast cells and histamine release lead to hives in pressure urticaria, and that the illness might possibly be more prevalent with autoimmune conditions.

Therefore, having an autoimmune disease may also make you more susceptible to this kind of chronic urticaria. Among the examples are:

• hypothyroidism
• celiac disease
• type 1 diabetes
• lupus
• rheumatoid arthritis
• Sjögren disease

Up to 9.8% of patients with pressure urticaria had autoimmune hypothyroidism, the most prevalent of these conditions.

How is pressure urticaria diagnosed?

Make an appointment with a physician to get a diagnosis if you think you may have pressure urticaria symptoms. First, they will assess your medical history as well as your current symptoms and indicators.

The diagnosis of pressure urticaria may need a process of elimination because its symptoms are frequently confused with those of other types of chronic inducible urticaria.

To ascertain whether an autoimmune component should be taken into consideration, a physician may also prescribe antibody testing. In this instance, the underlying autoimmune disease may also be treated.

How is pressure urticaria treated or managed?

When symptoms appear following trigger exposure, pressure urticaria, like other forms of chronic urticaria, can negatively impact your general quality of life.

Although difficult, severe swelling and itching can be treated. The only effective treatments for pressure urticaria that are currently advised are antihistamines. These function by lowering mast cell histamine release.

For those with extreme itching, oral corticosteroids might also provide instant symptom relief.

Short doses of systemic corticosteroids may help lessen the intensity of symptoms and shorten the flare-up period for acute flare-ups of chronic pressure urticaria. It cannot be treated with topical corticosteroids.

Before using antihistamines to treat pressure urticaria, it’s crucial to consult a physician. They may even suggest a prescription-strength version in addition to offering you advice on the best brand and dose.

Although antihistamines are thought to be the first-line treatment for the symptoms of pressure urticaria, scientists are looking into potential substitutes. Monoclonal antibodies like omalizumab (Xolair) are among them.

What can you do to prevent pressure urticaria?

While treatment can help reduce CIndU symptoms, it cannot stop them. Therefore, avoiding the activities that cause pressure urticaria as much as possible is the best way to prevent its symptoms.

For example, you can:

• instead of carrying a bag over one shoulder, wear a cross-body bag or a backpack, and keep your hands and feet away from objects for extended periods of time.
• put on airy, loose clothing that doesn’t press against your skin.
• when riding a bike or horse, take breaks to stretch your legs and reduce the amount of time that heavy objects are in contact with your skin.

Takeaway

Any chronic swelling and unusual hives should be evaluated by a physician. See a doctor as soon as possible if you observe that symptoms appear in response to pressure stimuli.

Treatments for pressure urticaria can help lessen symptoms and enhance your general quality of life, even when the precise causes are unknown.

The likelihood of reoccurring episodes can also be decreased by avoiding any known physical triggers.