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Many substances have been identified as itch “triggers” in patients with eczema, and triggers are not the same for every person. Many times it is difficult to identify the exact trigger that causes a flare-up. For some, it seems that rough or coarse materials coming into contact with the skin causes itchiness. For others, feeling too hot and/or sweating will cause an outbreak. Other people find that certain soaps, detergents, disinfectants, contact with juices from fresh fruits and meats, dust mites, and animal saliva and danders may trigger itching. Upper respiratory infections (caused by viruses) may also be triggers. Stress can also sometimes aggravate an existing flare-up.

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It is important for all eczema sufferers to be aware of proper eczema care and what this involves. Especially because if you leave your eczema condition it will only continue to get worse, and so you really need to make sure that you care for your skin properly in order to avoid flare-ups and maintain relief from your symptoms as best as you can.

Treating eczema is very important, and here a few of the best eczema care tips that you can use to deal with this difficult condition.

Avoid Triggers

One of the best and most important things you can do to deal with your eczema is avoid the triggers that aggravate your condition. There are going to be certain specific things which may irritate your skin and which you are therefore going to want to avoid.

Try to avoid contact with anything that is going to make your eczema break out, including soaps, gasoline, turpentine, aftershave lotions and various other solvents.

Moisturize

Another of the most important eczema care tips is to moisturize your skin. You should be doing it at least once a day, more if you can. Keep in mind that rather than pouring on a whole bunch of moisturizer, you will be much better off to just spend a bit more money and buy a better quality cream, and then use small amounts of it.

Medicines

Eczema care often requires medicine, and although there are certain medicated creams and lotions you can buy over the counter, for the more serious eczema medicines you will have to get a prescription from your doctor.

When you need eczema care, for instance when your eczema starts to act up, it is important that you use the medicine prescribed by your doctor. This will usually involve a strong medicine that you will need to rub on the affected area, but remember that you should follow the instructions and not think that you can make it better by using more than you were told to.

Proper diet and exercise are also going to play a major role here, and so if you want to get control over your eczema condition you should make sure that you are eating a healthy, well balanced diet, and getting regular exercise.

Try to stick to low intensity exercises, because if you do ones that are more strenuous you will end up sweating and this can end up irritating your condition as a result.

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Skin is not dry because it lacks oil, but because it lacks water. Symptoms most associated with Xeroderma (dry skin) are scaling, which is the visible peeling of the outer skin layer, itching and cracks in the skin. The good news is that today, there are several types of natural treatments to choose from for your dry skin.

Skin also harbors many nerve endings that provide the sense of touch and heat. Skin is considered one of the most important parts of the body. The skin is often known as “the largest organ of the human body”.

The dermis is tightly connected to the epidermis by a basement membrane. The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. Epidermis is the outermost layer of the skin.

The skin loses moisture and may crack and peel, or become irritated and inflamed. Forced-air furnaces make skin even drier. Environmental factors such as exposure to sun, wind, cold, chemicals, or cosmetics, or excessive bathing with harsh soaps, can cause dry skin. Nutritional deficiencies, especially deficiencies of vitamin A and the B vitamins, can also contribute to dry skin.

Use as little soap as possible limiting its use to armpits and genitals. Drink plenty of water every day. Use a humidifier if the air is dry.

Eat at least one organic apple with the skin on every day. Consider taking cod liver oil or fish oil supplements every day. Concentrating on a diet of lots of fruits and vegetables (preferably uncooked) and no junk food, should give you an observable improvement within 30 days. Good skin is often a reflection of a good digestive system. Fatty acids are particularly important to people with dry skin.

Use bath oils and moisturizers, especially coconut oil, which is the best natural product fr dry skin, at least daily. Also use a thin layer of coconut oil under your make-up to moisturize your skin all day. Apply a thin layer of coconut oil and massage it deep into the skin. Apply coconut oil anytime to heal and soothe your skin.

Sunlight, water and air play an important role in keeping the skin healthy. The skin must be regularly cleaned or it’ll become cracked or inflamed. The skin supports its own ecosystems of microorganisms, including yeasts and bacteria, which cannot be removed by any amount of cleaning.

Skin doctors are called dermatologists. Usually, these days, we can take care of dry skin without seeing our doctor, but sometimes we can’t avoid it. See your doctor or naturopathic doctor if your skin doesn’t improve in spite of your best efforts.

What can be done to treat dry skin?

The following are some tips that will complement your treatment of dry skin:

- Limit amount of soap you use.
- Limit the length of time you are exposed to hot water.
- Use a humidifier to keep adequate indoor levels of humidity.

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My nephew had mild bouts with eczema as an infant. Since he was so young, there weren’t any additional irritations from him scratching and he didn’t seem to be uncomfortable due to the rash. My sister used an over-the-counter cream to treat the spots of eczema. Thankfully, the condition seems to be in remission as he comes upon his 5th birthday.

What is Eczema?

Eczema is a condition that affects the skin and causes inflammation and an itchy red rash. The affected area can also be surrounded with small fluid-filled sacs that look like blisters and may ooze.

There are several different types and causes of eczema. I will be focusing on infantile eczema, sometimes called atopic dermatitis—the most common cause of eczema. Infantile eczema occurs in infancy, but affects children at any age. Conditions that occur when someone is sensitive to things in their environment like pollen, mold, pet dander or certain foods, are called “atopic.” Dermatitis describes the condition of the skin when it is inflamed, or red and sore. Eczema is often referred to the “itch that rashes” because sometimes a spot will be itchy, and scratching will cause a rash to develop. Resisting or avoiding scratching will aid in the healing of the rash, and help to avoid making it worse.

Causes of Eczema

Eczema is thought to be connected to genetic factors. Many children who get eczema also have family members with hay fever, asthma, or other allergies.
Allergies can trigger eczema, although it’s not an allergy in itself, as well as environmental and emotional factors; stress can bring on eczema. Children with eczema may also develop hay fever or asthma later on in life.

One out of every 10 children will develop eczema, almost always by the age of five. The good news is that kids dealing with eczema today will likely have outgrown it by the time they are teenagers.

Symptoms of Eczema

Every child experiences a unique culmination of symptoms that range in severity, so diagnosing eczema can be tricky. It’s possible to confuse eczema with other types of dermatological conditions like seborrheic dermatitis (commonly known as cradle cap), psoriasis (another genetic disease that causes the skin to become scaly and inflamed), and contact dermatitis which is caused by direct contact with an irritating substance such as metal, medicine or soap.

In determining a diagnosis, a doctor will examine the look and location of the rash; take a family history of allergies, hay fever and asthma, and possibly test to see if the child has developed any allergies.

List of symptoms:

• Itching with or without a rash
• A rash that looks red and/or scaly possibly with small blisters
• An oozing rash
• Thickening of the skin from rubbing or scratching

Home Remedies

• Plenty of water to help keep the skin hydrated and free of toxins and impurities
• For a great skin wash, boil the following ingredients together for 35 minutes. Let cool and use it to wash the affected area:
1tsp. comfrey root
1tsp. white oak bark
1tsp. slippery elm bark
2 cups of water
• Make sure to include plenty of food rich in B complex vitamins in your diet to assist in the healing and prevention of eczema.
• Vitamin E used topically will soothe and relieve the itching.

Things to avoid that will help your child feel more comfortable:

• Avoid hot baths, hot water tends to dry out the skin and exacerbate the problem
• Use mild soap or non-soap products to bathe your child
• Pat dry with a towel after bathing and avoid excessive scrubbing or toweling
• Help your child to avoid over-heating
• Avoid scratching

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It is common for people to suffer from itching at one point of time or the other. That is, under the watch strap, shirt cuff, tight ring, tight belt, areas where we sweat more, overgrown hairy area or while wearing unclean socks / under garments or when exposed to dust / chemical or from creeping insects or insect bites. These external factors will go off immediately if one eases the situation by giving a gentle scratch or rub. But the feeling of itchy caused due to Unpleasant feeling tickling, pricking, creeping, annoying
* Uncontrollabe scratching
* Burning pain after scratching
* Restlessness and irritability, causing disturbances in work and sleep

Diagnosis

Examination of the skin usually helps only when there is a localised cause. Also, the itchy part will be seen as scratched, injured, ulcerated part, so the exact picture of itch presentation will be mostly masked. The cause of itch can be analysed with skin swab and its culture. The other common investigation which helps to analyse the cause are: Tc, Dc, Esr, Hb, absolute eosinophil count, blood sugar, liver function test (especially bilirubin), urea, creatinine and thyroid function tests.

PREVENTION & MANAGEMENT

Even simple care can prevent itching i.e. Keep the skin moist and cool. Other do’s and dont’s are:

Do’s

* Control scracthing
* Wash / clean the part
* Use moisturiser to avoid dryness of skin
* Keep nails short and trimmed
* Maintain personal hygeine / cleanliness
* Dry the sweat fast
* Have a good shower twice a day
* Wear loose cotton underclothes / dresses

Take

* A lot of water to keep good body hydration
* Fresh fruits and vegetables for healthy skin especially carrot, apple, pineapple, papaya, orange, lime, cherry, ginger, beet root, spinach, etc.
* Vitamins A, C and zinc supplements for healthy skin

Avoid

* Scratching
* Long time exposure to direct sunlight and hot places
* Tight fitting / synthetic clothes
* Undue sweating
* Allergic substances - food / soaps / pollen / chemicals / drugs
* Strong soaps, powders, perfumes
* Hot bath
* Stimulants: coffee, alcohol, smoking and chewing tobacco
* Preservative added tin packed foods / drinks
* Unnecessary medications

COMPLICATIONS

Itching as such won t produce any complication i.e. if one resists the temptation to scratch or manages temporarily with just simple and slight rub, to stop the itching temporarily. But when itching gets suppressed with ointments or is scratched with nails or gets infected in the scratched area, then complications begin. The first and foremost one is burning pain as if the injured skin is rubbed against chillies. Also, since it arises mostly as a subjective feeling with uncontrollable character, it won t let one concentrate on any other activity. It can also develop into sleep disorder. Itching can also lead to eczema or other skin disorders. Even though it is bothersome, unless otherwise suppressed, it won t lead to serious illnesses.

GENERAL TREATMENT

Mostly no one goes to a doctor just for itching, in initial stages. They would ignore / manage with simple talcum or prickly heat powders or skin soothing / smoothening lotions (calamine). But recurrent and persistent bouts of itching often compel one to opt for treatment. Modern school of medicines usually prescribe anti- histamines with Vit C supplements. Sometimes, in violent itching cases, they also prescribe steroids either as a topical cream or as oral tablets depending upon the localised or generalised presence of itching. Anyway, each one has its own adverse effects. Phototherapy / UV rays therapy are also often tried to manage the situation.

HOMEOPATHIC APPROACH

Saying is easy and following is tough. This is wholly true about itching. Everyone who advises to stop itching does not realise the actual discomfort of the sufferer. Likewise, the pleasure of scratching (?) cannot be understood by others as it is felt by the sufferers. The sufferer will be led to great frustration if one attempts to suppress the temptation to scratch.

Itching is apparently suppressed by the modern school of medicines by just applying artificial moisturiser or having allergic (anti-histamines) medicines or supplementing vitamins and minerals. This palliative type of treatment works for that day only and also usually drives the disease inner or deeper to cause structural damages. Till the itch remains on the surface, it seems it is going away, but when it is arrested or suppressed, it will burst inside. This can be seen in many cases. For example, some may get asthma when suppressing eczema, some would get fits when suppressing itching rashes, some would have inner organs affected while suppressing the itch just with ointments or anti-histamines. In many cases, itching rebounds with greater intensity after being suppressed. Also, if the suppression type of treatment is followed for quite a long time, then it is not only tough to cure the case, but also difficult to treat or manage its side-effects which may endanger life.

Skin complaints are the toughest to treat, since skin is the outer most part of the body and more prone to exposure to irritants which hinder the healing process. The rational treatment should always be directed towards the cause of the disease rather than suppressing or eliminating the effects. Internal Homeopathic medicines can clear the persisting condition once and for all, but it needs some time, i.e., one should have patience to enjoy the benefit. In Homeopathy, Miasm Psora is meant for itch which is the base or start-up of any disease. With Homeopathy, the whole disease could be annihilated without any side-effects.

Homeopathic medicines commonly used for itch are Acid nit, Apis mel, Cantharis, Graphites, Hepar sulph, Merc sol, Nat mur, Petroleum, Psorinum, Radium Brom, Rhus tox, Sarasaparilla, Silicea, Staphysagria, Sulphur, Tellurium, Thuja, Zinc met, etc. Even though, there are lots and lots of drugs in homeopathy for itch, the main stalwarts are Sulphur and Psorinum. These medicines should be taken under the advice and diagnosis of a Qualified Homeopath.

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IT came as no surprise to mum-of-three Andrea Walker when she noticed patches of eczema begin to develop on her youngest, Eva.

Her two older daughters, Casey, 11 and Elise, three, had both suffered with the skin condition, which is thought to be largely hereditary. With both older girls Andrea had tried a variety of emollients, but what worked for one didn’t necessarily work for the other.

“At first, you’ll try anything and with Casey I did try quite a lot of things,” she remembers. “I found with many treatments it was trial and error in different combinations. Then a neighbour told me about Lesley at Little Herbal and a cream she was making. Now I’ve found something that worked I won’t change it.”

The cream she used is called, Themba, developed by Little Herbal International, based in Holmfirth, Yorkshire. Former pharmaceutical worker Lesley Robinson launched the company after a trip to Zimbabwe, where the remedies originate from traditional medicine.

Themba is made from the sausage-shaped fruit of the Kigelia tree, which grows in low lying altitudes of Southern Africa. The Kigelia fruit has been traditionally used for stubborn dry-skin conditions but can be used to soothe a variety of ailments such as acne, cold sores, athletes foot and insect bites.

Little Herbal has added aloe excelsia, calendula, wheatgerm oil, lavender and vitamin E to the cream, which seems to be suitable for the most sensitive of skins, even babies, promoting healing at the same time as tackling skin problems associated with viruses, bacteria and fungus.

Open-minded

“I think with a condition like eczema you’ve just got to be open-minded,” Andrea says. “We’re doing a bit of everything - looking at diet as well as skin care.

“Elise is on a dairy free diet because she is allergic to milk and eggs, which was aggravating her condition. We found out after she was hospitalised with asthma and the doctors did some tests, so we’ve been advised to keep her on a dairy free diet until she is about five and then try again. We tried all sorts, including adding acidophilus to her breast milk to rebalance the gut, and I rubbed a capsule of evening primrose oil into her thighs for the essential fatty acids to help reduce inflammation. Sometimes we had to use hydrocortisone cream, but it’s steroids-based so you worry about that - you don’t want to put anything very strong on the face.

“Casey’s skin isn’t upset by her food and her eczema is more seasonal now. It flares up in winter so we go back to using Themba and it calms down. With the other two I use Themba morning and night religiously. It helps keep it under control - I can tell if I’ve missed a bit because they’ll have a red patch.”

Eva was just seven weeks old when she developed a patch of red dry skin behind her ears, but in two months it had spread to her face, legs and body.

“I cried when I saw the patch,” Andrea admits. “I knew straight away it was eczema. It’s upsetting because you just want your baby to be peaches and cream. People stare and say, `Aw, what’s that on her face?’ You know they are being sympathetic but you just want it to clear up. It’s very sore as well - Eva’s skin was inflamed and hot. I dressed her in simple white cotton and put little mitts on her hands to stop her from scratching but she would be up all night crying with the pain. She was sleep-deprived as a result and I was, too.

“Sometimes, you just want someone to really listen to you and Lesley was a big support for me in that way. Together we put together a plan of action and she also put me in touch with an immunologist at the hospital who suggested that Eva take a small dose anti-histamine, twice a day.

“That stops her skin feeling itchy so she’s not scratching it - hence she’s not making it sore and not getting infected skin. It also means the Themba can do its own job of healing the skin without having to work doubly hard to stop the itching as well.”

Aggressive

As seen in the photos, when Eva’s eczema flares up it is very aggressive, red and hot. To try and reduce the inflammation Eva was one of the first to use a new cream from Little Herbal, Oshana (African for dry place), which contains the active ingredients of Themba mixed with other ingredients known to be kind to the skin, like aloe and vitamin E. It can be used in between applications of Themba to moisturise the skin.

“On the photos you can see the eczema was very aggressive on Eva’s face,” says Andrea. “We didn’t realise at the time but she had got some of it infected. When we went to the doctors they said that because I’d been using Oshana it had kept it under control.

“Because with eczema you need to get a lot of moisture into it, we used Oshana head to toe on Eva and then rub on Diprobase ointment (A mixture of liquid paraffin and white soft paraffin that produces a greasy moisturiser. It works by providing a layer of oil on the surface of the skin to prevent water evaporating). Once that’s soaked in we have a completely peachy little girl.”

Although there is no catch-all treatment for eczema there are things you can do to help minimise discomfort:

Keep your baby’s skin moisturised, especially after a bath. Emollients reduce water loss from the skin by providing a seal or barrier so the skin is less dry, itchy and more comfortable.

Bathing your baby in lukewarm water can help his/her skin retain moisture and stay hydrated

To reduce itching use cotton clothing and bedding, which keep the skin cool and allow it to breathe. At night, cotton mittens can be used over babies’ hands to help reduce damage to the skin during sleep.

Reduce house dust mites, which can aggravate the condition, by regularly vacuuming, damp dusting and airing bedding.

Dietary changes can be quite helpful although it is important to seek advice from a nutritionist in order to ensure your child is getting adequate nutrients. Keeping a diary of foods eaten and observing skin reactions can be useful when weaning babies.

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People who suffer from acne are desperate to get rid of this affliction. Those who have the money, spare no expenses in the treatment for acne. Those who have not are always on the look out for some good tips from their friends or Internet. This article today will show you some very simple remedies for acne that any one can perform with excellent results.

Why Spend Good Money If You Can Get All The Acne Help From Your Own Kitchen?

The treatment of acne, whether through a doctor or through the million and one ads that keep popping up is usually very expensive? This is why it is out of reach for many people. Many do not know however, that there are sufficiently potent ingredients in your own kitchen to get as much acne help as you wanted and needed. Let us see what those magic ingredients are.

1. Acne help No 1 - Plain old vinegar - most of the times, people use apple cider vinegar for the treatment of acne. However, you should note that any vinegar is as efficient in cleaning your skin of the extra oiliness, and killing off the facial bacteria which cause the infection. You can use a solution of 8:1 water: vinegar directly applied onto the face with cotton; leave it to dry and rinse after ten minutes.

2. Acne help No 2 - Lemon – this citrus is an excellent cleanser of skin. The lemon juice can be rubbed on the face and then cleaned the next day morning. This will ensure that you have your skin totally oil-free and hence healthy as it could be.

3. Acne help No 3 - Egg white – this has mainly used as an instant face lift agent. It also absorbs extra oiliness from the skin as well as helps in exfoliating the facial skin. Take the egg white, beat it a little and then apply on the face. As soon as it dries up, maximum 15 minutes, rinse it off.

4. Acne help No 4 – Vitamin B5 is exceptionally potent in controlling acne. You will need to take this Vitamin in dosages of about 10 grams per day in order to really make an impact on the acne; and this should be done daily.

5. Acne help No 5 – Oatmeal – this is a very basic and simple way to have the oiliness off the face absorbed. To use it, you will need to boil it, cool it and then apply to the affected area. Once it dried up, remove it and observe the excellent feel of the skin.

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While many people are still battling February snow and ice storms, those of us in more moderate southern climates are already planning and planting our spring gardens.

Unfortunately, we’re also already battling the dry skin, eczema and other skin problems caused by working with earth, weed killers and pesticides. How can gardeners prevent this damage? Using non-toxic gardening products will help both your hands and your overall health, but many gardeners have also found that a good shielding lotion prevents dry skin and gives their hands the protection they need.

How does a shielding lotion help? The skin’s surface layer consists of oils, fats and dead skin cells. While that may not sound very appealing, this layer is the skin’s protection. It prevents moisture from escaping and chemicals from penetrating – two of the most common factors that cause eczema, dry skin and other skin problems.

When the surface layer is damaged by chemicals, dirt or abrasive substances, the oils, fats and dead skin cells are stripped away, leaving our skin dry and virtually covered with tiny, invisible cracks through which moisture escapes and toxic chemicals penetrate. As this damaged layer comes into contact with more chemicals, the surface layer is broken down even more and, before you know it, you have a chronic dry skin problem.

Unfortunately, most traditional moisturizers can’t help. While they do create the illusion of soft, supple skin, what you’re actually feeling is the product itself. Underneath, the skin is not actually healing and the dry skin condition is getting worse - which is why we continue to battle dry skin year after year and are constantly on the lookout for a new and better product.

Many gardeners think they’ve finally found the product they’ve been looking for – here’s what they have to say about shielding lotion:

“After years of gardening, my hands felt like leather with our mucky black soil. I started using shielding lotion and after about a week I noticed my hands were looking very different. They were looking so good, I started having manicures for the first time in my life. I actually started wearing polish and was not ashamed of my hands.”

“Shielding lotion applies like hand cream, leaving my hands smooth and soft but providing a barrier against the dirt, the stains and the penetrating grunge I am always getting my hands into as I work in the greenhouses potting and cutting and in my work shop with my many projects. The best feature is the penetrating coverage, guarding against dirt, stains and grunge.”

A good shielding lotion bonds with the outer layer of the skin to form a new protective layer that locks in moisture and keeps out chemicals so your skin can actually heal itself.

If you’re an avid gardener, give shielding lotion a try. It may be all the dry skin care treatment you need, and you’ll be able to enjoy your favorite pastime without ruining your hands!

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Allergic contact dermatitis is a special pattern of reaction that occurs when your skin comes into contact with a foreign substance (allergen) that your skin is sensitive or allergic to.

The development of the allergic reaction is related to the “sensitising potency” of the allergen and various host factors.

Allergens vary in their potential to induce allergy, eg the chemical urushiol in poison ivy can sensitise most people; nickel sensitises 10% to 20% of women, while many other allergens sensitise a smaller minority.

The susceptibility of an individual to sensitisation is related to genetic factors.

The hallmark of allergic contact dermatitis is that the rash occurs almost exclusively at the site where the offending agent or allergen comes into contact with the skin. Common locations include the face, neck, hands and feet. The rash usually has features of redness, swelling, itching and exudation of fluid.

The common allergens that cause allergic contact dermatitis are nickel, rubber additives, fragrance, chromium, paraphenylenediamine (PPD) and colophony.

Nickel is the most common allergen worldwide. It is present in alloy metal jewellery, keys, coins, belt buckles, clothing studs and metal spectacle frames.

Ear piercing significantly increases the risk of developing nickel sensitivity.

Common sites of the rash seen in nickel sensitivity are the earlobes (related to jewellery), around the navel (related to clothing studs and belt buckle), the back (related to brassiere fasteners) and around the wrists (related to watch straps and buckles).

Allergy to rubber products is usually due to the chemical additives used in the manufacture of the rubber rather than the latex itself. Dermatitis from rubber additives is common in the rubber and tyre manufacturing industry. Domestic contact is normally from rubber gloves. Rubber chemicals in shoes can also cause a dermatitis of the feet.

Fragrance materials are a common cause of allergic contact dermatitis. Fragrances have widespread use. They are found not only in perfumes and cosmetics but also in hair and skin care products, laundry products, cleaning products and toothpaste. It is more common for the source of fragrance exposure to be a skin or hair care product rather than a cologne or perfume itself.

Chromium is found in cement, plaster, anti-rust paint and chromium plating. It is a common cause of allergic contact dermatitis in masons and construction workers. The rash usually occurs on the back of the hands and the forearms.

Paraphenylenediamine (PPD) is commonly found in hair dyes and causes a dermatitis on the scalp, ears, face and neck in many individuals who use these dyes. PPD is also found in black rubber products like rubber boots, diving suits and rubber hoses.

Colophony or rosin is obtained from the sap of pine trees. It is mainly used in the manufacture of adhesives, glues, paper and printing ink. Dermatitis due to adhesive tape is fairly common and is usually due to colophony.

Apart from the allergens discussed above, there are numerous substances that can cause an allergic contact dermatitis. Sometimes the cause and effect relationship is not obvious.

For instance, nail varnish is a fairly common cosmetic sensitiser. The culprit is the formaldehyde resin in the lacquer base of the nail varnish. Since the nail is made of inert material, no reaction occurs on the nail or nail bed.

However, sites that are often touched by the nails, for example the eyelids, neck and chin, can develop a rash due to sensitivity to the resin. Thus a rash suspected to be allergic contact dermatitis should be carefully assessed by a doctor.

Sometimes special skin allergy tests called “patch tests” may be necessary to try to identify the allergen. If an allergen can be identified, avoidance of contact with the substance is of great importance in our endeavour to clear the rash and prevent its reoccurrence.

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Urticaria or hives appear as red, itchy, raised areas of skin (weals) that can take various sizes and shapes. The size can range from a few millimetres to many centimetres. They can be round or they can form rings or join together as very large raised patches.

The distinct characteristic of urticaria is their tendency to change quickly in terms of size and location. The rash can disappear and reappear often in a matter of hours.

Hardly any other skin disease can appear and resolve so rapidly. From the history and description, a doctor can often make the diagnosis even in the absence of visible rash.

However, with the ready availability of small cameras and hand phones with built-in cameras, it is helpful if the patient can take a photo of the rash and show it to the doctor.

Urticaria is due mainly to the release of a chemical called histamine from special cells in the skin called mast cells. Histamine causes the local blood vessels to become more permeable or porous, thus allowing fluid to leak out, leading to swelling in the skin.

The trigger for the mast cells to release histamine is usually an allergic reaction, but other circumstances like direct physical stimulation (eg temperature extremes, pressure and exercise) can occasionally cause the release of histamine and hence, urticaria as well.

Swelling deeper in the skin that may accompany urticaria is called angioedema. This often occurs around the eyes and lips but can also be seen in the hands, feet and elsewhere.

Urticaria is conventionally divided into acute urticaria (lasting less than six weeks) and chronic urticaria (lasting more than six weeks).

In acute urticaria, a cause for the reaction can often be found. The common causes are:

1. Food – seafood, nuts (especially peanuts), dairy products, fruits (eg strawberry), chocolate.
2. Drugs – antibiotics (eg penicillin, sulphonamides), aspirin, drugs for pain and rheumatism (eg ibuprofen).
3. Blood products
4. Viral infection and febrile illnesses
5. Radio-contrast media (for x-rays and scans).

In chronic urticaria, a definite cause usually cannot be found. Some cases can be due to specific food additives like dyes, preservatives and taste enhancers (eg tartrazine, amaranth, sunset yellow, sodium benzoate, sulphates, monosodium glutamate).

Infections, eg dental sepsis, helicobacter pylori and intestinal parasites, may be occasional causes.

Recent research suggests that a subset of chronic urticaria can be due to autoimmunity where the body produces antibodies to certain normal constituents of the mast cells. The autoantibodies can cause release of histamine from the cell.

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