Urticaria Images: 29 Clinical Photos Of Hives Types

Urticaria, also known as hives, is characterised by recurrent, transient, raised pruritic lesions called weals or wheals. Individual weals are typically oedematous pink or red plaques that may be surrounded by a red flare or halo and usually resolve within 24 hours without scarring.

This image gallery showcases a diverse range of urticaria presentations, including acute urticaria, chronic spontaneous urticaria, and various forms of chronic inducible urticaria such as pressure urticaria, cold urticaria, heat urticaria, solar urticaria, and others. Images are organized by body region and urticaria subtype to aid clinical recognition and diagnosis.

Acute urticaria images

Acute urticaria lasts less than 6 weeks and often resolves spontaneously within hours to days. It may be triggered by infections, medications, foods, or idiopathic factors. Characteristic features include multiple fleeting weals of varying sizes that migrate across the skin surface.

• Image 1: Classic acute urticaria on the trunk showing multiple annular wheals with central pallor and surrounding erythema. Lesions appeared suddenly after NSAID ingestion
• Image 2: Acute urticaria on the arms with serpiginous (snake-like) configuration of coalescing wheals. Note the intense pruritus reported by patient
• Image 3: Facial acute urticaria with periorbital swelling (angioedema component). This presentation occurred post-viral infection in a child
• Image 4: Palmar acute urticaria showing deep dermal oedema creating tense bullae-like lesions. These resolved within 48 hours

Chronic spontaneous urticaria images

Chronic spontaneous urticaria (CSU) persists >6 weeks without identifiable triggers. Daily or near-daily weals occur spontaneously, often with angioedema in 40% of cases. Disease burden is assessed using UAS7 (Urticaria Activity Score over 7 days).

• Image 5: Typical CSU on the back demonstrating polymorphic wheals of different sizes and shapes co-existing simultaneously
• Image 6: Severe CSU with confluent wheals covering >50% body surface area. UAS score: 6/6 on examination day
• Image 7: CSU affecting pressure-dependent sites (waist, bra-line) showing linear wheals following skin folds
• Image 8: Refractory CSU on lower legs despite high-dose antihistamines. Note residual hyperpigmentation from resolved lesions

Pressure urticaria images

Delayed pressure urticaria (DPU) is a chronic inducible urticaria triggered by sustained pressure/weight. Weals develop 3-12 hours after stimulus (vs immediate in dermographism) and may persist 24-72 hours. Common sites: feet, hands, buttocks.[10]

• Image 9: Classic DPU on soles after prolonged standing. Painful deep dermal swellings appeared 6 hours post-exposure[10]
• Image 10: DPU on palms following manual labour/grip pressure. Lesions show haemorrhagic crusting due to prolonged duration
• Image 11: Buttock DPU after sitting 4+ hours. ‘Comb-like’ pattern follows chair contact pressure distribution[10]

Cold urticaria images

Cold urticaria manifests after cold exposure (air, water, objects). Two main types: immediate (5-10 min post-exposure) and delayed (3-12 hours). Systemic reactions possible with large-area exposure.

• Image 12: Ice cube test positive: weal develops 5 minutes after ice removal from forearm
• Image 13: Cold water immersion urticaria on legs after swimming in cool pool. Note sharp demarcation at waterline
• Image 14: Facial cold urticaria after consuming cold beverage. Perioral pallor with surrounding wheals

Heat urticaria images

Heat urticaria (rare) develops within minutes of direct heat contact or exercise-induced heat. Localised weals at heat application site; systemic symptoms rare. Tolerance may develop with repeated exposure.

• Image 15: Localised heat urticaria on forearm after hot water bottle application (44°C × 5 min)
• Image 16: Exercise-induced heat urticaria on trunk appearing 10 minutes into brisk walking

Solar urticaria images

Solar urticaria occurs within minutes of UV/visible light exposure. Weals confined to sun-exposed areas; pruritus intense. Action spectrum varies (UVA, UVB, visible light).

• Image 17: UVA-induced solar urticaria on neck/V-area after 10 minutes sun exposure
• Image 18: Visible light solar urticaria on hands after window glass exposure

Dermographism images

Dermographism (skin writing) is the most common inducible urticaria. Linear weals form along stroking/shearing pressure lines within 1-3 minutes.

• Image 19: Positive dermographism test: tongue blade stroke produces immediate white wheal line
• Image 20: Severe dermographism on back spelling patient’s name via firm fingernail tracing

Cholinergic urticaria images

Cholinergic urticaria triggered by heat, sweat, exercise, spicy foods. Uniform 1-4mm satellite wheals surround central punctum; highly pruritic/stinging.

• Image 21: Classic cholinergic urticaria on chest post-exercise: pinpoint wheals with erythematous flare
• Image 22: Severe cholinergic urticaria covering axillae, trunk during hot shower

Urticarial vasculitis images

Urticarial vasculitis mimics urticaria but lesions last >24 hours, burn > itch, and resolve with purpura. Biopsy shows leukocytoclastic vasculitis.

• Image 23: Urticarial vasculitis on legs: persistent wheals with central purpura after 48 hours

Angioedema images

Angioedema involves deeper dermal/subcutaneous swelling, often affecting face, lips, extremities. May co-exist with urticaria or occur independently.

• Image 24: Hereditary angioedema: massive tongue swelling obstructing airway
• Image 25: ACE-inhibitor angioedema: asymmetric periorbital and lip swelling

Paediatric urticaria images

Children commonly present with acute urticaria, often infection-associated. Chronic forms less frequent but require age-appropriate management.

• Image 26: Acute urticaria in toddler covering abdomen, thighs post-viral exanthem
• Image 27: Annular urticaria on infant’s back resembling erythema multiforme

Treatment response images

Demonstrates urticaria resolution patterns and potential adverse effects from therapy.

• Image 28: CSU dramatic response to omalizumab 300mg: complete clearance after 2nd injection
• Image 29: Post-prednisone purpura in patient with urticarial vasculitis exacerbation

Frequently Asked Questions

What do urticaria lesions look like?

Urticaria appears as pink/red raised wheals with surrounding flare, intensely itchy, resolving <24hrs without marks. Acute: fleeting migratory; chronic: daily persistent.

How is urticaria diagnosed from images?

Fleeting weals <24hrs, no scarring = urticaria. Persistent >24hrs + purpura = vasculitis. Inducible types show trigger-site specificity.

What triggers cause these urticaria patterns?

Spontaneous (idiopathic), pressure (delayed deep), cold (ice test+), heat/exercise (cholinergic puncta), solar (light-exposed).[10]

Which urticaria type shows satellite lesions?

Cholinergic urticaria: 2-3mm punctate wheals with erythematous halo after sweating/exercise.

When do pressure urticaria weals appear?

Delayed 3-12 hours post-pressure, painful, persist 24-72hrs vs immediate dermographism.[10]

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medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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