Hives (Urticaria) Treatment in Clovis & Fresno, CA
Hives — medically known as urticaria — are one of the most uncomfortable and alarming skin reactions a person can experience. The sudden appearance of intensely itchy, raised welts across the skin can disrupt sleep, work, and daily life, and in some cases may signal an underlying medical condition that requires evaluation. At Dehesa Dermatology, board-certified dermatologist Dr. Luis A. Dehesa provides expert evaluation and management of both acute and chronic urticaria for patients throughout Clovis, Fresno, and the Central Valley — helping you find relief and identify the cause when possible.
What Are Hives?
Hives are raised, red or skin-colored welts (wheals) that appear suddenly on the skin and are typically intensely itchy. They vary widely in size — from a few millimeters to several centimeters — and can appear anywhere on the body, including the face, trunk, arms, legs, and throat. Individual hive lesions characteristically come and go, with each individual wheal typically resolving within 24 hours, though new ones may continuously appear in other areas. Hives are caused by the release of histamine and other inflammatory mediators from mast cells in the skin, triggered by a wide range of stimuli.
Hives are classified by duration:
- Acute Urticaria: Hives lasting less than 6 weeks. Most often triggered by a specific identifiable cause — a food allergy, medication reaction, infection, or insect sting.
- Chronic Urticaria: Hives occurring on most days for 6 weeks or longer. In the majority of chronic urticaria cases — particularly chronic spontaneous urticaria — no external trigger is identified. Chronic urticaria is often driven by autoimmune mechanisms and can significantly impact quality of life over months to years.
Common Causes and Triggers
Identifying the cause of hives, particularly acute episodes, guides treatment and prevention. Common triggers include:
- Foods — particularly peanuts, tree nuts, shellfish, fish, eggs, and milk
- Medications — most commonly NSAIDs (ibuprofen, aspirin), ACE inhibitors, and antibiotics
- Infections — viral illnesses are a leading cause of acute urticaria, particularly in children
- Insect stings and bites
- Latex exposure
- Physical triggers: pressure (dermographism), cold, heat, exercise, vibration, or sunlight (solar urticaria)
- Underlying autoimmune conditions — particularly thyroid disease and autoimmune disorders, relevant for patients who may benefit from our rheumatology services
Hives Treatment at Dehesa Dermatology
Treatment depends on the type, severity, and underlying cause of urticaria:
- Second-Generation Antihistamines: Non-sedating H1 antihistamines (cetirizine, fexofenadine, loratadine) are the first-line treatment for all types of urticaria. Higher than standard doses are often required for adequate control in chronic urticaria.
- H2 Antihistamines: Added to H1 antihistamines for improved control in some patients.
- Oral Corticosteroids: Short courses for severe acute urticaria episodes when antihistamines alone are insufficient.
- Omalizumab (Xolair): An injectable biologic that targets IgE and has transformed the management of chronic spontaneous urticaria that does not respond to antihistamines. FDA-approved for this indication and highly effective for patients with refractory chronic hives.
- Trigger Avoidance: For identified physical or specific triggers, avoidance strategies are incorporated into the management plan.
- Evaluation for Underlying Conditions: In chronic or unusual urticaria presentations, laboratory testing to screen for thyroid disease, autoimmune conditions, and other systemic causes may be recommended.
Frequently Asked Questions About Hives
Are hives dangerous?
Most hives are uncomfortable but not dangerous. However, hives accompanied by swelling of the lips, tongue, throat, or difficulty breathing — signs of angioedema and anaphylaxis — require immediate emergency medical attention (call 911). At Dehesa Dermatology, we evaluate and manage urticaria comprehensively, but patients with known severe allergic reactions should carry an epinephrine auto-injector (EpiPen) as prescribed by their allergist or physician.
What is the difference between hives and angioedema?
Hives affect the superficial layers of the skin, producing raised, red, itchy welts. Angioedema involves deeper swelling in the skin and subcutaneous tissue — typically presenting as swelling of the face, lips, tongue, hands, or feet without the surface redness and itch of classic hives. The two conditions frequently occur together and share similar causes. Angioedema affecting the throat is a medical emergency requiring immediate care.
How long do hives last?
Individual hive lesions typically resolve within 24 hours, though new ones may appear continuously. Acute urticaria — hives lasting less than 6 weeks — resolves in the majority of cases once the trigger is removed or the underlying infection resolves. Chronic urticaria lasts 6 weeks or more and often requires ongoing medical management. With appropriate treatment including omalizumab when necessary, most patients with chronic urticaria achieve excellent long-term control.
Can stress cause hives?
Yes — emotional stress can trigger or worsen urticaria in susceptible individuals. Stress does not directly cause the allergy but can lower the threshold for mast cell activation and histamine release, making existing urticaria worse. Stress management is a useful adjunct to medical treatment for patients with stress-sensitive urticaria.
What is dermographism?
Dermographism — literally “skin writing” — is a form of physical urticaria in which firm stroking or pressure on the skin produces raised, itchy wheals along the path of the stroke within minutes. It is one of the most common forms of chronic urticaria and can be triggered by tight clothing, towel rubbing, or scratching. It responds well to antihistamines and typically improves or resolves over time.
When should I see a dermatologist for hives?
See a dermatologist if your hives are severe, recurring, or have been present for more than 6 weeks. Chronic urticaria requires professional evaluation to rule out underlying medical causes and to establish an effective long-term treatment plan. At Dehesa Dermatology, we offer the full range of urticaria management including omalizumab (Xolair) for patients whose hives don’t respond to antihistamines. Call (559) 951-9000 to schedule your evaluation.
Does Dehesa Dermatology treat chronic hives for Fresno patients?
Yes. We treat acute and chronic urticaria for patients from Fresno, Clovis, and the Central Valley. Our practice is located at 978 N Temperance Ave in Clovis, easily accessible from Fresno via Highway 168. If you’ve been struggling with hives and haven’t found lasting relief, call (559) 951-9000 to schedule a comprehensive urticaria evaluation.