Does an itchy, red rash or ‘hives’ that persists on and off bother you? If so, you may be suffering from what is known in medical lingo as chronic spontaneous urticaria (CSU), more commonly known as wheals or welts. These wheals or hives appear without warning, last for at least six weeks and can suddenly reappear after having cleared.

The wheals, though they may vary in size, are usually 1-2 cm across and look like mild blisters and are itchy. There may be just a few but sometimes many develop over various parts of the body. Each wheal usually last less than 24 hours however as the rash may constantly come and go the ongoing itch may cause distress and difficulty in sleeping.

As everyone’s skin is different so is everyone’s experience of CSU is different. Some people with CSU also experience swelling (angioedema) with hives; in this condition some fluid also leaks into deeper tissues under the skin, which causes the tissues to swell. The swelling (angio-edema) can affect any area of the skin, but the eyelids and lips are most commonly affected areas of the body. Sometimes the tongue and throat are affected and become swollen. The swelling sometimes becomes bad enough to cause difficulty breathing.

In the absence of an external trigger, managing this little-known skin disease is difficult but not impossible

Symptoms of angio-edema tend to last longer than urticarial wheals. It may take up to three days for the swollen areas to subside.

As CSU is more than skin deep, its effects too are more than skin deep; alongside the distressing physical symptoms, CSU can be a great psychological and social burden. Embarr-assment and a lack of self-confidence can impact relationships, social lives and work. CSU patients can experience a loss of control over their lives. CSU’s spontaneous nature and a lack of clear cause or what triggers it may leave people living in fear of an outbreak. In other words it’s not only during bad days but even when the skin is clear and there are no apparent signs of the disease, CSU can be an emotionally demanding condition as the threat of sudden outbreak hangs over the people who suffer from CSU.

But all is not doom and gloom. Your dermatologist can reduce your suffering and help you to be truly comfortable in the skin you live in.

CSU is not an allergy, and unlike other conditions with hives has no known external triggers. If you suffer from it, it is not your fault. Fortu-nately, 50 per cent patients with CSU will experience remission within one year. Overall, treatment is geared towards symptomatic management. Individuals with chronic urticaria may need other medications in addition to antihistamines to control symptoms. Patients that experience urticaria with angio-edema require emergent treatment as this is a life threatening condition.

The mainstay of therapy for chronic urticaria is patient education, avoiding triggers and antihistamines. But failure to follow diagnosis and management guidelines can lead to a significant delay in diagnosis, referral and treatment. It is best to consult a dermatologist in case one experiences a recurring problem.

Published in Dawn, Sunday Magazine, October 5th, 2014