skin disorders
Hives
Evaluation of Hives
Not every episode of hives requires immediate evaluation by a doctor. The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. Certain symptoms and characteristics are cause for concern: Swelling of the face, lips, throat, tongue, or airways (angioedema) Difficulty breathing, including wheezing Hives that are deeply colored, that become open sores, or that persist for more than 48 hours Fever, swollen lymph nodes, jaundice, weight loss, and other symptoms of a bodywide (systemic) disorder People should call an ambulance if They have difficulty breathing or are wheezing. Their throat feels as if it is closing up. People should go to an emergency department or a doctor's office as soon as possible if Their symptoms are severe. They feel progressively weak or light-headed or have severe fever or chills. They are vomiting or have abdominal pain or diarrhea. People should see a doctor if A bee sting triggers hives or swelling (to obtain advice about treatment if another bee sting occurs). They have other symptoms, such as fever, joint pains, weight loss, swollen lymph nodes, or night sweats. Hives recur without exposure to a trigger. Symptoms last for more than 2 days. If children have hives that appear suddenly, disappear quickly, and do not recur, an examination by a doctor is usually unnecessary. The cause is usually a viral infection. Doctors first ask questions about the symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done ( see Table: Some Causes and Features of Hives ). Doctors ask the person to describe each episode of hives in detail and any other symptoms that occurred (such as Itching , difficulty breathing, or The trigger is not always clear from the history, often because the trigger is something that may have been tolerated previously. During the physical examination, doctors first check to see whether the lips, tongue, throat, or airways are swollen. If there is swelling, they begin treatment right away. Then doctors note how the hives look, determine which parts of the body are affected, and check for other symptoms that may help confirm the diagnosis. Doctors may use various physical stimuli to see whether they can trigger the hives. For example, they may apply light pressure, heat, or cold to the skin or stroke the skin. People themselves should not try to trigger their hives, because a severe reaction could occur. Usually, testing is not needed for a single episode of hives unless symptoms suggest a specific disorder that requires treatment (such as some infections). But if hives have unusual characteristics, recur, or persist, tests are usually done. Typically, tests include a complete blood cell count and blood tests to measure levels of electrolytes, sugar (glucose), and thyroid-stimulating hormone and to determine how well the kidneys and liver are functioning. Skin tests, such as a Diagnosis , are done by an allergist (a doctor who specializes in allergic disorders) to identify specific allergens. Imaging and other blood tests are done based on results of the history and physical examination. If results suggest that the cause is a bodywide disorder, a thorough evaluation is needed to identify the cause. A skin Biopsy is done if the diagnosis is unclear or if hives last more than 48 hours. 