[44F] With swelling and hives on limbs

Patient Description

A 44-year-old female presents with swelling in the hands, feet, and halfway up the legs and arms, accompanied by hives on the lower legs. The hives started 3-4 days ago, a couple of days after the swelling began. They cover the area from the ankles up 2-3 inches and have progressed from light and small to covering the entire area, although the color remains the same. The patient reports pain, itching, and burning sensations in the affected areas. Occasionally, she experiences nausea and dizziness, but denies difficulty breathing, facial swelling, fever, chills, rapid or irregular heartbeat, chest pain, or tightness. Her skin feels extremely hot to the touch, as noted by her spouse. There has been no recent exposure to new medications, foods, environmental factors, personal care products, or substances like alcohol, tobacco, or recreational drugs. She has no family history of allergies or similar skin conditions, is up to date with vaccinations, and has no known medical conditions or chronic illnesses. The patient is not currently taking any medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Allergic Reaction: Swelling, hives, itching, and burning sensations can be signs of an allergic reaction. This could be due to something you came into contact with, even if you don't recall any new exposures. Allergic reactions can sometimes occur without a clear trigger.

    • Treatment: Antihistamines (like Benadryl) can help reduce itching and swelling. Topical corticosteroid creams may also help with the hives and itching. In severe cases, a doctor may prescribe stronger medications.
  • Angioedema: This is a condition characterized by deep swelling beneath the skin, often around the eyes and lips, and sometimes in the throat. It can be associated with hives and can be triggered by allergies, medications, or even stress.

    • Treatment: Similar to allergic reactions, antihistamines and corticosteroids are commonly used. In severe cases, epinephrine may be necessary.
  • Vasculitis: This is an inflammation of the blood vessels that can cause changes in the skin, such as hives and swelling. It can be associated with pain and a burning sensation.

    • Treatment: Treatment often involves corticosteroids and other medications to reduce inflammation. A doctor would need to perform specific tests to diagnose this condition.
  • Infection: Although you haven't had any recent infections, some infections can cause skin reactions and swelling. This is less likely given your lack of fever and chills, but it's still a possibility.

    • Treatment: If an infection is suspected, antibiotics or antiviral medications may be necessary.

What you can do

While you should consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Over-the-Counter Medications: Consider taking an over-the-counter antihistamine like Benadryl to help reduce the itching and swelling. Follow the dosage instructions on the package.
  2. Topical Treatments: Apply a corticosteroid cream to the affected areas to help with the itching and burning. These are available over-the-counter or by prescription.
  3. Cool Compresses: Applying cool compresses to the swollen and itchy areas can provide some relief.
  4. Avoid Triggers: Try to identify and avoid any potential triggers, even if they are not immediately obvious. This could include certain foods, environmental factors, or stress.
  5. Hydration: Drink plenty of water to stay hydrated, which can help your body manage the symptoms.
  6. Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and get insights. This information can be very helpful for your healthcare provider.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Difficulty breathing or swallowing
  • Swelling of the face, lips, or tongue
  • Severe or worsening pain
  • Development of a fever (temperature over 100.4°F) or chills
  • Rapid or irregular heartbeat
  • Any other concerning symptoms

Remember, while this advice can help you manage your symptoms, it is important to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What are common causes of swelling and hives without known allergies?

Common causes of swelling and hives without known allergies can include stress, infections, or idiopathic reactions where the exact trigger is unknown. Sometimes, exposure to a substance that you have not previously reacted to can also cause these symptoms.


How can I differentiate between an allergic reaction and angioedema?

An allergic reaction typically involves hives, itching, and swelling, often with a known trigger. Angioedema involves deeper swelling, particularly around the eyes and lips, and can occur with or without hives. Angioedema can also be triggered by stress or medications.


What are the signs that my skin condition might be due to vasculitis?

Signs that your skin condition might be due to vasculitis include persistent pain, burning sensations, and changes in skin color or texture. Vasculitis can also be associated with systemic symptoms like fatigue or joint pain. A healthcare provider can perform specific tests to diagnose vasculitis.


When should I seek urgent medical attention for swelling and hives?

You should seek urgent medical attention if you experience difficulty breathing or swallowing, swelling of the face, lips, or tongue, severe or worsening pain, development of a fever or chills, or a rapid or irregular heartbeat.


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