wheals

What are wheals?

Wheals describe small water retentions in the top layer of skin (epidermis) . These appear as pale reddish to whitish raised spots or plateaus on the skin, which can be rounded or irregular in shape. The wheals usually measure a few millimeters to two centimeters. Sometimes the skin irritations can be accompanied by itching or burning.

Wheals usually develop as a result of an irritant effect on the skin, such as an insect bite . The stimulus causes the release of tissue hormones from the mast cells, such as histamine. The histamine increases the permeability of the blood vessels and ultimately leads to small water retention, which shows up as wheals. As soon as the hormones bind to the sensitive nerve fibers, itching occurs in the skin area.

What is angioedema?

Angioedema describes deeper, widespread, rapidly developing, painless and rarely itchy swellings of the skin and mucous membranes that can occur alone or together with wheals. They are also known under the older name Quincke’s edema. Typical regions for the development of angioedema are the palms of the hands, the soles of the feet as well as the eyelids and lips.

Serious symptoms, such as difficulty breathing, can occur if the tongue, throat or larynx are affected by the severe swelling. Angioedema can be caused by the same triggers as wheals, more rarely they occur as a side effect of certain medications. In addition, the hereditary disease “hereditary angioedema” leads to recurrent severe angioedema.

Causes of Wheals

Hives (urticaria): The disease hives arises as a result of increased histamine release in the context of various causes. The name urticaria derives from the Latin word for stinging nettle, “urtica”, since the skin irritation is strongly reminiscent of the wheals caused by stinging nettles. A distinction is made between acute spontaneous urticaria and inducible urticaria .

• The acute spontaneous form of hives describes a spontaneous development of the disease that disappears completely within six weeks. For example, the symptoms can occur as part of an infection of the upper respiratory tract or the gastrointestinal tract . Also, it can be an allergic reaction to an insect bite or a food intoleranceand drug intolerance can lead to spontaneous urticaria. Sometimes no specific cause of hives can be found. The skin wheals appear all over the body, especially on the shoulders, abdomen, thighs and forearms. As a rule, the skin wheals disappear on their own within a few minutes to hours.
• In the case of chronic spontaneous urticaria , the symptoms last longer than six weeks. In this case, chronic infections such as chronic sinusitis, tooth root inflammation or tonsillitis can be behind the symptoms. Food intolerance to certain ingredients such as preservatives, colorings or flavorings can also lead to the symptoms. Autoreactive urticaria describes wheal formation in which endogenous substances lead to the release of histamine from the mast cells. In rare cases, no cause can be found.
• The wheals of inducible urticaria are caused by external stimuli to the skin such as pressure, cold, heat, physical activity or light. The symptoms of this form of hives only show up in the area of ​​the stimulus and usually subside within an hour. In the context of contact urticaria, contact with some plants can lead to the formation of wheals, which are sometimes very itchy. The most well-known example is the stinging nettle.

Allergies: Wheals can occur as part of an allergic reaction . On the one hand, the skin irritations can show up locally in the area of ​​the skin that has come into contact with an allergy-causing substance (allergen). On the other hand, the wheals can also be generalized, i.e. occur all over the body, for example as part of a food intolerance or drug intolerance. Contact with pollen can also lead to reddening of the skin and wheals.

Insect Bites: Some insect bites can also cause skin irritation around the bite site. These include, for example, mosquitoes, horse flies, stable flies, fleas and ticks.

diagnosis

One-off spontaneous occurrence of the symptoms is no reason to search for the exact cause or to seek therapy.

In order to make the correct diagnosis, the doctor treating you will ask you a few precise questions about your symptoms during the brief anamnesis interview. He will also ask you if you have any allergies or food intolerances.

This will be followed by a physical exam, during which the doctor will take a close look at the skin.

A blood sample can also provide information about the cause and is particularly indicated in the presence of chronic urticaria. In addition, an allergological skin test using a prick test can provide information on the presence of allergies.

If there is a suspicion of a food intolerance, this can be determined with the help of a low-pseudoallergen diet (natural and self-prepared food and dishes). The patient tries to avoid food additives. If an improvement in the wheals can be achieved, this speaks for the presence of intolerance urticaria.

Under certain circumstances, it can be helpful if the patient keeps a symptom diary in which he documents the appearance of the skin wheals in detail. The location, the duration and possible triggers such as temperatures, food or medication taken should be noted so that it is easier to draw conclusions about the cause afterwards.

duration of wheals

As a rule, wheals disappear on their own within a short time. As soon as the triggering stimulus is absent, the skin irritation should also recede. In the context of an infection, it can take several weeks for the symptoms to subside again.

You can do this even with hives

Some patients report an improvement in symptoms as soon as the affected areas of skin are cooled. However, this should only be considered if the symptoms are not triggered by cold (cold urticaria). Patients with chronic urticaria are also recommended to avoid alcohol and NSAID drugs. You can also try to minimize everyday stress. Relaxation techniques or physical activity can help.

Therapy of urticaria

Depending on what triggers the wheal formation, the therapy should be coordinated individually between the patient and the doctor. If, for example, a bacterial inflammation is the cause behind the symptoms, antibiotic therapy may help. As soon as a food or drug intolerance is suspected to be causing the symptoms, a diet and a change in medication should be tried. In the case of medication, it is often the additives and not the actual active ingredient that causes the symptoms. Changing the preparation can make sense here.

So-called antihistamines can help to relieve severe symptoms and itching . The tablets can be purchased in pharmacies without a prescription. Antihistamines target the tissue hormone histamine and can thus alleviate the symptoms. The most common side effects of antihistamines are fatigue and poor concentration. If the symptoms are very severe, the antihistamines must be administered via the vein during a hospital stay.

In addition, therapy with glucocorticoid-containing agents can be attempted in the context of an acute flare-up.

When to see a doctor

Although wheal formation is in most cases caused by a harmless disease, a medical evaluation should be considered. Sometimes the small skin irritations can be mistaken for other serious and contagious diseases.

The following reasons make a visit to the doctor absolutely necessary:

• A reddish circle forms around the wheal. In this case, it can be Lyme disease as a result of a tick bite that can be days or weeks ago.
• The wheal shows no improvement even after several weeks.
• In addition, symptoms such as pain, swelling, overheating and severe redness occur. This indicates the presence of infection of the affected skin area and a doctor should be consulted.
• In addition to the wheals, fever, cold symptoms and a poor general condition occur.

How can Med-Healths help?

Have you noticed wheals on you? You can use the Med-Healths app to contact a doctor and describe your symptoms in a video call. You can also upload photos of the skin change for the appointment. In many cases, the doctor can prescribe medication for you, issue a prescription and, if necessary, write you off sick. In addition, we can refer you to an appropriate specialist practice if further examinations are necessary.