Urticaria on the face
Pro Research Analysisby 
Searched over 200M research papers
Urticaria on the Face: Causes, Symptoms, and Management
Introduction to Urticaria on the Face
Urticaria, commonly known as hives, is a skin condition characterized by raised, red welts that can appear anywhere on the body, including the face. These welts are often itchy, sting, or burn and can vary in size from small spots to large patches . Urticaria can be acute or chronic, with acute cases lasting less than six weeks and chronic cases persisting longer 23.
Symptoms and Characteristics of Facial Urticaria
Pruritic Erythematous Lesions
Facial urticaria presents as pruritic (itchy), erythematous (red), raised lesions with central pallor that blanch with pressure 23. These lesions can appear on the periorbital (around the eyes) and perioral (around the mouth) regions, as well as other parts of the face 23. The lesions typically last less than 24 hours before fading, leaving normal skin .
Angioedema Association
Approximately 40% of individuals with urticaria also experience angioedema, which is characterized by deeper swelling of the skin and mucous membranes. Angioedema commonly affects the face, including the lips, tongue, and throat, and can be more severe and persistent than urticarial lesions 239.
Causes and Triggers of Facial Urticaria
Allergic Reactions
Urticaria on the face can be triggered by allergic reactions to various substances, including food products, medications (such as aspirin, nonsteroidal anti-inflammatory drugs, and antibiotics), and insect stings 23. Contact urticaria, a subtype, occurs after direct contact with allergens like cosmetics or disinfectants, leading to localized facial reactions .
Autoimmune Factors
Chronic urticaria may have an autoimmune basis, with associations found between urticaria and autoimmune hypothyroidism (Hashimoto's disease). Patients with chronic urticaria often have higher incidences of antithyroid antibodies and circulating IgG antibodies directed against the IgE receptor 23.
Environmental and Physical Factors
Environmental factors such as UV light exposure and physical factors like pressure or temperature changes can also trigger urticaria. In some cases, persistent facial erythema and edema, known as morbus morbihan, have been linked to immunologic contact urticaria and impaired lymphatic drainage .
Diagnosis and Differential Diagnosis
Clinical Evaluation
Diagnosis of urticaria is primarily clinical, based on the characteristic appearance of the lesions and patient history. It is essential to differentiate urticaria from other skin conditions that can mimic its presentation, such as urticarial vasculitis, erythema multiforme, and various autoinflammatory or autoimmune disorders 69.
Histopathological Examination
In cases where the diagnosis is uncertain, a skin biopsy may be performed. Histopathological findings typically show a mixed infiltrate of eosinophils and neutrophils in the dermis, which supports the diagnosis of urticaria .
Management and Treatment
Antihistamines
The first line of treatment for urticaria is the use of second-generation H1 antihistamines, which help alleviate itching and reduce the appearance of welts 23. These medications are effective in managing both acute and chronic urticaria.
Avoidance of Triggers
Identifying and avoiding known triggers is crucial in managing urticaria. For contact urticaria, avoiding the causative agent, such as specific cosmetics or disinfectants, can prevent recurrence .
Corticosteroids and Immunosuppressants
In severe cases, oral corticosteroids may be prescribed to reduce inflammation. For chronic urticaria with an autoimmune component, immunosuppressants or biologics targeting specific immune pathways may be considered .
Conclusion
Urticaria on the face is a common and often distressing condition characterized by itchy, red welts. It can be triggered by various factors, including allergies, autoimmune conditions, and environmental exposures. Accurate diagnosis and effective management, including the use of antihistamines and avoidance of triggers, are essential for alleviating symptoms and improving patient quality of life.
Sources and full results
Most relevant research papers on this topic