Fast Five Quiz: Chronic Spontaneous Urticaria

William D. James, MD


June 15, 2020

Figure 2. Hives following MMR vaccine

Transient pruritic hives are a key characteristic of CSU and the majority of other forms of urticaria.

Painful or burning hives are associated with urticaria vasculitis, presenting a diagnostic challenge when evaluating patients with chronic urticaria. Patients with urticaria vasculitis have wheals that persist for > 24 hours and are typically more painful than itchy. The resolving wheals in urticaria vasculitis result in pigment changes or scaling.

Although patients with CSU may have angioedema, a positive history of transient pruritic hives is the main characteristic of this condition.

Crusted and painful lesions that follow a dermatome are associated with herpes zoster, not CSU.

Learn more about the clinical presentation of CSU.


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