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Living with chronic (long-term) hives can bring unexpected challenges. One day, your skin feels fine, and the next, it’s covered with itchy bumps that show up out of nowhere. For people with darker skin tones, hives don’t always look like the medical images that pop up when you search for “chronic hives” online. Bumps that might be commonly described as red or pink may actually look skin-colored, darker, or even purplish on skin of color.
In this article, we’ll discuss how chronic hives may appear on Black skin and other darker skin tones. We’ll also share why hives can be missed or misdiagnosed and what treatment options can help you find relief. Finally, you’ll learn what triggers to avoid and simple self-care tips to help improve your quality of life.
Chronic hives, or chronic urticaria, is a condition where raised, itchy welts appear anywhere on your skin. The welts can range from small bumps to large areas that feel warm, swollen, and irritated. While most hives fade within a few hours or days (acute hives), chronic urticaria lasts much longer. People with chronic hives have them at least twice per week for six weeks or more. They may appear daily or off and on for months to years.
Chronic hives affect about 2 percent of people worldwide. While research on people of color with hives is limited, studies suggest that chronic hives are more common in African Americans — especially older adults.
While hives can appear on every skin tone, they don’t always look the same. On Black and brown skin, color changes can be more subtle, so it’s important to pay attention to texture and how your skin feels, too.
On darker skin tones, chronic hives may appear the same color as your natural skin tone. Or, they may appear slightly darker or a purplish-gray color. Most commonly, they look like raised welts — swollen, itchy patches that feel different from the surrounding skin. They may range in size from pea-sized bumps to larger areas that merge together. Because color changes can be subtle on darker skin, texture and swelling are important signs to note.
Even if the color change is faint, you may notice that the bumps feel warm, puffy, or raised above the surrounding skin. They may appear suddenly, disappear, and then reappear in the same area or somewhere else.
When the skin rash goes away, people of color may see dark spots, called hyperpigmentation, left behind in the area where the hives were. Hyperpigmented spots may last for weeks to months.
Since discoloration may not be visible on darker skin, you might look for other clues that show you’re experiencing chronic hives. These signs may include:
If you notice any of these signs, take note of when and where they occur so you can let your healthcare team know.
Hives are often very itchy. The itching can range from mild to intense. Depending on the type of chronic hives you have, they may be worsened by heat, exercise, or stress. Some people describe a burning, tingling, or stinging feeling under the skin. The affected areas may also feel tight, swollen, or tender to the touch.
When swelling happens in the deeper layers of the skin, it’s called angioedema. Though less visible, it can be painful and sometimes serious. Angioedema tends to affect the lips, eyes, and genitals, but it can also appear on the hands and feet.
For some, the constant itch and discomfort can make it hard to sleep or focus during the day. These sensations and psychological effects are just as important as how your skin looks and should always be shared with your doctor.
People with dark skin may experience more challenges than people with light skin when obtaining a diagnosis for chronic hives. Limited training for dermatologists and fewer reference images of chronic hives on darker skin tones can play a role, sometimes causing hives to be mistaken for eczema, dermatitis, or insect bites.
There’s a lack of representation in medical imaging for how skin conditions affect dark skin tones. Because of this, healthcare providers may have received more training on how to recognize the visible symptoms of hives on people with light skin.
It’s important to track your own symptoms as much as you can. If you suspect you have chronic hives or you’re just not sure why your skin may be itching or swelling, ask your doctor about the following steps to a chronic hives diagnosis.
To diagnose chronic hives, your doctor will start by asking questions about your symptoms, including when they first appeared, how long they last, and what seems to trigger them. They may do a skin exam and order blood tests to look for allergies, thyroid problems, or other autoimmune conditions, such as lupus or diabetes.
Doctors often check to see if hives are blanchable, which means the hives turn a lighter color when you press on them. On black and brown skin, this change may not be visible, so it’s important to look at other options for diagnosis.
In some cases, your doctor may order a skin biopsy. During this procedure, your doctor will remove a small skin sample to be examined later under a microscope. This helps confirm the diagnosis or rule out other conditions that can look similar to chronic hives.
Your doctor may also do provocation testing if they suspect chronic inducible urticaria. This involves safely exposing your skin to a possible trigger to see if hives appear. It helps identify what might be causing your hives and how sensitive your skin is to certain triggers.
Some other skin conditions can resemble chronic hives. Your doctor may need to rule out these possibilities before confirming your diagnosis:
Tracking your symptoms can make a big difference when living with chronic hives. Write down when your hives appear, what you were doing before they started, and how long they typically last. Note any foods, drinks, or medications you’ve taken — even common ones like ibuprofen or aspirin — along with your stress levels, the clothing you are wearing, and weather conditions.
This simple habit can help your doctor spot patterns and identify possible triggers. For people with chronic urticaria, some of the most common triggers include:
Over time, your notes may reveal helpful clues that can guide your treatment plan and make it easier to manage flare-ups before they start.
Chronic hives can be challenging — especially if healthcare providers initially misdiagnose your symptoms. Even so, effective treatments are available. Many people find relief through over-the-counter medicines like antihistamines. Simple home remedies, like applying a cool compress, wearing loose clothing, and avoiding known triggers, can also soothe symptoms.
If your hives last longer than six weeks or keep coming back, talk with your healthcare provider or a dermatologist. They’ll work with you to create a treatment plan that addresses your symptoms and fits your needs.
On MyChronicHivesTeam, people share their experiences with chronic hives, get advice, and find support from others who understand.
What do chronic hives look like on your skin? Let others know in the comments below.
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