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Have you ever had a gnat bite, one that itches to the point of distraction, where you know that you shouldn't scratch, but can't stop yourself? Now imagine how that feels, but multiply the itch by a thousand and imagine that itch covering vast swathes of your body. If you've managed to imagine what that feels like, then you're halfway to imagining what it feels like to have Urticaria. I've suffered from Urticaria on and off for the last thirteen years and am in the middle of the worst outbreak yet.
==What is Urticaria?==
Urticaria is actually a pretty common skin condition that will affect up to one in five of the population at some point in their lives. Also known as hives or nettle rash, Urticaria presents as an intensely itchy rash that forms raised wheals on the skin. As the itch is all-encompassing, stopping yourself from scratching is next to impossible, but scratching will actually intensify the itch and make the rash worse. I'm not sure I fully understand the process even now, but from what I can work out the wheals (raised white bumps surrounded by red skin) are formed when the body releases a number of inflammatory chemicals including histamines which cause blood vessels to leak fluid. The wheals can vary in size from tiny bumps to several centimetres in diameter, with the larger wheals also causing significant swelling.
Urticaria falls into two main categories, acute where the rash lasts less than six weeks and chronic where it lasts longer. With acute Urticaria the cause is normally an allergic reaction, and the rash will normally present within hours of contact with the allergen. Chronic Urticaria is more complex and is rarely caused by an allergy. I personally suffer from chronic Urticaria, and while it's not an allergy, it is aggravated by several different factors.
Among the various factors that aggravate my Urticaria are body heat (cholinergic), pressure, stress and hormones. If I'm already in a flare-up then getting too warm will cause the rash to intensify, as will the pressure of clothes on my body, being stressed and even the time of the month. Other less common triggers are cold, water, vibration and the sun, while a far more common trigger (that I do not have) is dermatographic, where the rash appears when the skin is scratched.
Another common cause of chronic Urticaria is an auto-immune disease with research concluding that in up to 30% of chronic idiopathic (no known cause) Urticaria, patients spontaneously develop auto-antibodies to their skins cells. (In layman's terms, their body mistakes skin cells for invaders and starts attacking them). I'm currently being investigated for this, and to be honest am in two minds as to what I want the result to be. While I really don't want to have an auto-immune disease, in a way it would be nice to have a reason for the rash.
Although Urticaria is rarely life-threatening, it is a debilitating condition that can cause the sufferer severe discomfort and lead to depression. There are also a few scenarios where immediate medical advice should be sought. The most obvious of this is where the rash and it's associated swelling spreads to the neck and face and breathing becomes laboured. If you suffer from Urticaria and this happens then you should dial 999 and ask for an ambulance, so as to get immediate treatment.
Treatment for Urticaria is a bit hit and miss, there is no cure, so all any medication will do is alleviate or reduce the symptoms. Antihistamines are normally the first line of attack, starting with the newer types then progressing to stronger types if necessary. In severe cases where antihistamines are having limited (or no) effect then steroids may be prescribed as these reduce inflammation, but these can only be used for short periods as they have some nasty side-effects. While hydrocortisone creams may be prescribed in cases of acute Urticaria, these can again only be used for a short timeframe as extended use can cause the skin to thin. Emollients (moisturisers) may provide short term relief (a few minutes) from the itching, along with helping keep the skin soft (Urticaria really dries out the skin). If symptoms are particularly severe and prevent the sufferer from sleeping, then a short course of sleeping tablets may be prescribed, which can help break the itch/scratch cycle for a short time.
As to how long a sufferer may have Urticaria, well that really is a case of how long is a piece of string. For some sufferers the condition may clear up never to return within six weeks, but for others it may last for decades. In my case I've lived with this for over thirteen years now and every time I've thought I've seen the last of it, it once more rears it's ugly head.
==Me And My Rash==
My first ever outbreak of Urticaria was about thirteen years ago, when I came up in the rash on my hands and belly. Although at the time I thought this was the worst rash ever, it was easily controlled with antihistamines, as long as I took them everyday the rash was barely noticeable and didn't really impact with my life. Over the next decade the rash would come and go, whenever an outbreak started I would start to take antihistamines, which would control it and so I could continue with life as normal. But...
On February the fourteenth this year, while out for a romantic dinner, my wrists starting itching and the tail-tale rash started developing on my wrists. So I took my antihistamines as normal, something you learn after suffering from Urticaria for over a decade is to carry antihistamines with you at all times. Now normally within half hour of taking this tablet the rash would start to reduce, and it would be gone within an hour, but not this time. Over the next twenty four hours the rash intensified and spread, until it covered my arms, tummy, hands, feet, backside and legs. It's difficult to try and impress on just how painful and itchy this rash was, but I couldn't hold anything because my hands had swollen so badly, couldn't stand because of the pain on my feet and couldn't bear the feeling of clothes against my skin. By the early hours of the 16th I was in severe pain, and starting to go into shock (probably because of how much fluid was leaking from blood vessels into my skin), so an ambulance was called.
The severity of the situation probably didn't hit me at the time, all I wanted was for the itching to stop, but the paramedic and two ambulance crews should have probably given me a clue. After a long struggle to insert a canula (drip site) in my grossly swollen arms, I was given a dose of antihistamines that had no real effect, so I was transferred to hospital where I was given more antihistamines and steroids. These drugs did help a little, so I was sent home with more oral antihistamines, which would hopefully help reduce the severity of the attack.
Only they didn't, and the next day the rash started spreading to my face, more specifically my eyes, so I visited my GP, who prescribed yet another antihistamine along with oral steroids and sent me home with instructions that if it got worse I was to go back. I'm pretty sure you've already guessed what happened next. Yes the rash spread still further, in fact it was now on my neck, so I once more returned to the GP, who this time sent me back to the hospital (this time the Emergency Assessment Unit), where the umm-ed and ah-ed and decided that I wasn't suffering from Urticaria, but was instead I was having a reaction to a virus. They then decided to stop all my antihistamines and steroids, and then gave me a choice between going home or staying in under sedation, telling me it was going to get worse before it got better. Having an eleven month old baby, the choice was easy, but I wasn't prepared for how much worse it was going to get. Oh and they made me an emergency appointment with a dermatologist, just in case they were wrong.
Over that weekend, I steadily deteriorated, until I got to the point where the wasn't a part of my body that wasn't either itching or recovering from the rash. My feet were so painful and swollen that I couldn't put my shoes on, and I was so desperate that I considered using haemorrhoid cream on them that as it contains a local anaesthetic. I couldn't close my hands to fists, or even hold a knife and fork. Over the space of a week I Must have had maybe six hours of sleep and so I returned to my GP in desperation.
On revisiting the GP, I was once more given both steroids and antihistamines, as while they hadn't cleared the rash up, they had significantly reduced it (oh boy had I realised how much worse it was without them). I was also given some sleeping tablets, to help me get a little rest and break the scratching cycle at night. Once I'd restarted the antihistamines the rash did reduce a little in severity, not so much as I was itch free, but enough that I could start walking and closing my hands again. By this point I'd pretty much resigned myself to living with the rash for the foreseeable future, and was finding that rather than it being all over my body, it would be in one or two places at a time and as each flare up cleared a new one would begin. I will say though that even though I was on the strongest antihistamines my GP could give me, they would only work for about an hour at a time, so I made sure I took them just before bed along with the sleeping tablets so that I could at least fall asleep.
All this continued until I had my appointment with the dermatologist last week. At this appointment it was confirmed that this was a case of severe, idiopathic Urticaria, and I was prescribed an extremely high dose of antihistamines (four times the normal dose). Along with prescribing this medication, a biopsy of one of the wheals was taken. If you've never had a biopsy taken (like me) then this can come as a bit of a shock, so I'll explain what happens during the procedure. Firstly the consultant looked at the wheals to choose one that had emerged quite recently. Luckily, I had lots of wheals for him to choose from as both of my arms and my back had recently flared up. Once the site has been chosen, some local anaesthetic is injected under the skin. I'm terrified of dentists and this is when I really freaked out, because the needle looks exactly like the one dentists use. A few minutes later, that part of my arm had gone completely numb, and the doctor used a punch to take a remove small (3mm) circle of skin. I will say that this part of the procedure was completely painless, I could feel the skin being pulled but not cut. The wound was then covered with a seaweed dressing, which I needed to remove 24hours later. I've not had the results back from this biopsy, but will update when I do. No matter what the results, the treatment for the Urticaria remains the same.
After starting the much higher dose of antihistamines I started seeing an improvement within twelve hours. Although they do make me very drowsy, the antihistamines really do now seem to be having a positive effect. That night was the first night that I was able to sleep without taking sleeping tablets, and over the last four days the rash has steadily reduced in severity. It's not completely disappeared, but instead of it completely covering my limbs, there's just wheals here and there. I'm once more able to cuddle up under the duvet and my quality of life has improved one thousand fold. I'm under no illusions that this is the last I've seen of the rash, but feel far more hopeful that there is something that can be done next time is worsens.
==Some Tips From One Sufferer To Another==
Now I've told my story I thought I'd share some tips on coping with Urticaria.
1. Always carry antihistamines with you.
Although they didn't stop this flare-up in it's tracks, I often find that if I take an antihistamine as soon as I start itching it will stop it from developing into a full blown rash.
2. Know And Avoid Your Triggers
If you do know (or suspect) that something is causing or worsening your flare-ups then avoid it if you possibly can. If a flare-up does appear out of the blue, then think about everything you've come into contact with lately. Have you eaten something unusual, or maybe you've changed your washing powder.
3. Don't Scratch
Believe me, I know how impossible it is not to scratch, but I also know that scratching makes the rash far worse. Make sure your nails are short, and try putting pressure on the itchy points rather than scratching. Or try scratching against a piece of material, sometimes just the action of scratching helps.
4. Keep Cool
Unlike many rashes, Urticaria causes the skin to become quite hot to the touch, and heat makes the rash worse. If you can wear the minimum of clothing, and sit or lay beside an open window. The cool air will give some relief, but what ever you do don't go under a thick quilt.
==Take A Cool Bath==
The only relief I had when this flare-up was at it's worst was when I sat in a cool bath. As my skin cooled, it was an almost ecstatic feeling as the burning itch reduced in intensity. Just don't use anything in the bath that might irritate your skin, I used aqueous cream to wash with. Ok I didn't feel particularly clean but it was soothing.
Something I've found is that the itch scratch cycle makes my skin incredibly dry and I find moisturising several times a day extremely soothing. Again, don't use anything heavily perfumed, aqueous cream is nicely cooling, and I've found Lush Dream Cream very soothing.
==Keep Your Mind Occupied==
Try to keep your mind off the itching as much as possible, make sure your focus is anywhere other than the rash. I find that if I'm not doing anything then I scratch more, so read, play computer games, whatever you feel like. And if you can keep your hands occupied at the same time then more the better.
If the rash spreads to the face or neck and you have difficulty breathing then call an ambulance straight away. If you really aren't coping with the rash, it's severely disturbing your sleep or the wheals are lasting for more than 24hours in one place or bruising then see your GP as soon as possible.
Although it's relatively common, I don't think I know anyone else that suffers from chronic Urticaria and it does sometimes feel quite isolating. It can also be quite embarrassing, as I really can't help but scratch no matter where I am. This can lead to some funny looks when out on the street, I'm sure some people must jump to the conclusion that I have fleas. Hopefully, if you've just been diagnosed with the condition there's something above that helps, if only the fact that you're not alone. And if you've been suffering with the symptoms and not got a diagnosis yet, then perhaps this will tug a few bells and give you the push to see your GP. Either way, I've finished now, thanks for allowing me to share my experiences with you.