Hives (urticaria) are a rash that can be intensely itchy. The type involved in lupus typically lasts for more than 24 hours.
This article looks at the causes of lupus hives, how to identify and treat them, and what other lupus symptoms affect the skin.
Lupus and Hives
Lupus is an umbrella term for several related diseases. Frequent hives (chronic urticaria) are generally associated with the most common type, systemic lupus erythematosus (SLE).
SLE involves a misfiring immune system that attacks healthy parts of your body. Also, the inflammatory process is out of control, so it just keeps creating inflammation.
Hives are typically associated with allergies or infectious illnesses. That’s because they’re caused by a chemical in your body called histamine. Your immune system releases histamine when it senses a threat, such as dangerous bacteria, a bug bite, or something you’re allergic to.
The connections between lupus and hives aren’t fully understood. However, they’re both known to involve the immune system and inflammation.
Some research suggests that chronic urticaria may be associated with increased likelihood of developing SLE. A newer line of research is looking into whether they’re both autoallergies (allergies to the self).
What Do Hives Look Like?
Hives can appear as bumps, raised patches of skin, or both. Each hive can vary from the size of a pinhead to a few inches across, and you can have just one or clusters of them.
Autoimmune thyroiditis (Hashimoto’s) Rheumatoid arthritis Sjögren’s syndrome Celiac disease Type 1 diabetes
On light skin, hives generally appear pink or red. On the darker skin of Black or brown people, they may be the same color as your skin, slightly lighter, or slightly darker. A characteristic that distinguishes hives from some other rashes is that it blanches (turns white when you press on the skin).
Chronic urticaria involves episodes of hives that last for at least six weeks. These episodes sometimes last for months or even years.
Lupus Hives Treatment
Some standard SLE treatments may help with hives, but they may not be the best treatments for chronic urticaria.
H1 Blockers
The first-line treatment is an antihistamine (allergy medication) called H1 blockers. They interfere with how your body uses histamine. You may be prescribed up to four times the usual dose to manage your hives if necessary. (Don’t increase the dosage unless your healthcare provider recommends it.) Some H1 blockers are:
Zyrtec (cetirizine) Allegra (fexofenadine) Clarinex (desloratadine) Ilaxten (bilastine)
Additional Medication
For about half of people with lupus-related hives, these drugs alone aren’t enough to bring relief. Your healthcare provider may suggest other medications such as:
Antimalarial drugs: Plaquenil (hydroxychloroquine), Aralen (chloroquine) Leukotriene agonists: Singulair (montelukast), Accolate (zafirlukast), Zyflo (zileuton) Systemic steroids: Prednisone, prednisolone, methylprednisolone, beclomethasone, hydrocortisone H2-blockers: Tagamet (cimetidine), Pepcid (famotidine), Axid (nizatidine), Zantac (ranitidine) Other drugs: The asthma drug Xolair (omalizumab), the immunosuppressant Sandimmune (cyclosporine), the immunosuppressant/leprosy drug Dapsone (diamino-diphenyl sulfone)
Other Lupus Skin Problems
Lupus symptoms include several skin-related issues, varying from person to person. SLE skin symptoms include:
Malar rash (butterfly-shaped rash across the nose and cheeks) Photosensitivity (exposure to sunlight and some artificial lighting can lead to rashes) Livedo reticularis (lacy-patterned, blue, violet, or dark discoloration just under the skin) Alopecia (hair loss) Oral and nasal sores: (canker-sore-like ulcers) Raynaud’s syndrome: (cold temperatures cause tightening in the fingers and toes) Purpura (purple or red discoloration under the skin from leaking blood vessels) Cutaneous vasculitis (discolored patches that resemble hives but they don’t blanch)
If you have any skin problems, talk to your healthcare provider about how to treat and manage them.
When to See a Healthcare Provider
Any time you develop hives without a known reason, you should seek medical care. They could signify a serious allergic reaction or an undiagnosed underlying illness.
If you’re not diagnosed with lupus but have skin symptoms or other problems that may be linked to the disease, make an appointment with your healthcare provider. They may run tests or refer you to a specialist for diagnosis and treatment.
If you are diagnosed with lupus, let your healthcare provider know about:
New symptomsWorsening symptoms (flares)Possible drug side effects
Also, let them know if a new medication doesn’t appear to be working.
Summary
Lupus can cause hives, likely because of the two conditions’ common autoimmune and inflammatory aspects. Hives are raised, discolored areas of the skin. Some lupus treatments, such as Plaquenil and steroids, may help eliminate hives. However, antihistamines are typically the preferred treatment for hives. Always see a healthcare provider for hives, especially if you don’t know the cause.
A Word From Verywell
Hives can be severe and disruptive to your life. Adding them on top of your other lupus symptoms can be a lot to deal with. However, remember that hives can be treated. See your healthcare provider so they can rule out more urgent causes and get you on the path to treatment.
