From the Guidelines
Topical treatments for urticaria include over-the-counter 1% hydrocortisone cream, calamine lotion, and menthol-containing preparations like Sarna lotion, which can provide temporary relief of itching and inflammation. When considering treatment options for urticaria, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. The provided evidence 1 focuses on antihistamines, which are the cornerstone of urticaria treatment, but does not directly address topical agents. However, based on general medical knowledge and the example provided, topical treatments can be used as adjunctive therapy to alleviate symptoms. Some key options include:
- Over-the-counter 1% hydrocortisone cream, applied 2-3 times daily
- Calamine lotion
- Menthol-containing preparations like Sarna lotion
- Cold compresses to constrict blood vessels and reduce histamine release It's crucial to note that these topical agents only provide temporary relief and do not address the underlying cause of urticaria. Patients should also avoid exacerbating factors such as hot water, alcohol-based products, and fragranced lotions on affected areas. If urticaria persists or is accompanied by concerning symptoms, medical attention should be sought immediately.
From the FDA Drug Label
Uses For temporary relief of itching associated with minor skin irritations, inflammation and rashes due to: ● eczema ● seborrheic dermatitis ● psoriasis ● insect bites ● poison ivy, oak, sumac ● soaps ● detergents ● cosmetics ● jewelry ● external feminine genital and anal itching Purpose Anti-Itch
Topical agents for hives/urticaria include:
- Hydrocortisone (TOP), which can provide temporary relief of itching associated with minor skin irritations and inflammation, including those caused by insect bites and other allergic reactions that may cause hives 2 2. Key words: hydrocortisone, topical, anti-itch, urticaria, hives.
From the Research
Topical Agents for Urticaria (Hives)
- Topical corticosteroids may be used to reduce wheal size and itch severity in patients with urticaria, with low to very low certainty of evidence 3
- The use of topical corticosteroids may result in little to no difference in overall adverse events compared to placebo, with high certainty of evidence 3
- Other treatment options for urticaria include:
- Antihistamines, such as loratadine, cetirizine, and mizolastine, which are effective in treating chronic idiopathic urticaria 4
- Leukotriene receptor antagonists, such as montelukast and zafirlukast, which may be used in combination with antihistamines for patients who do not respond to antihistamines alone 5
- Immunomodulatory drugs, such as cyclosporine, which may be used in patients with severe, unremitting urticaria 5
- Other agents, such as sulfasalazine, methotrexate, and omalizumab, which may be used in certain cases of chronic urticaria 6
Mechanism of Action
- Topical corticosteroids work by reducing inflammation and suppressing the immune system, which can help to reduce the symptoms of urticaria 3
- Antihistamines work by blocking the action of histamine, a chemical that is released during an allergic reaction and causes blood vessels to dilate, leading to increased permeability and the formation of wheals 4
Efficacy and Safety
- The efficacy and safety of topical corticosteroids for the treatment of urticaria have been evaluated in several randomized controlled trials, with results showing a reduction in wheal size and itch severity compared to placebo 3
- The safety profile of topical corticosteroids is generally good, with little to no difference in overall adverse events compared to placebo 3