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Delayed pressure urticaria is a form of pressure urticaria, which is in turn a form of the condition most of us know as hives. Generally, doctors classify delayed pressure urticaria as a form of "pressure urticaria," which is the reason it's a little difficult to look up on the Internet.

Pressure urticaria is condition that causes whelps on the skin. These skin lesions can itch, burn, or ache. They can last from just three or four hours up to three or four days. Areas of skin where they break out can be subject to new breakouts for another one or two days even after the lesions heal.

Many different kinds of pressure on the skin can cause breakouts of pressure urticaria.

The breakouts have been known to occur after:

  • Insertion of a tampon.
  • Wearing tight clothing (belt, bra, shoes, watch band).
  • Sitting or standing on a hard surface.
  • Clapping hands.
  • Dental work.
  • Sex.
  • Using a tool, such as a hammer or saw.
  • Kissing.

The skin can break out around the waist, on the buttocks, palms of the hands, soles of the feet, legs, and genitals. There can be chills, fever, fatigue, and joint pain (arthalgia).

There is considerable overlap among hives, angioedema, dermographism, pressure urticaria, and delayed pressure urticaria. Delayed pressure urticaria is characterized by breakouts that occur usually about four hours after a trigger. However, in some people, the "delay" is just a few minutes. These people are said to have "pressure urticaria."

There is another condition that causes redness almost immediately after pressure on the skin called dermographism, literally "writing on the skin." Unlike pressure urticaria, dermographism does not cause anything other than redness of the skin. It does not result in the aches and pains that occur with pressure urticaria and delayed pressure urticaria.

Pressure urticaria and delayed pressure urticaria are classified as "idiopathic" urticaria, but there are also allergenic urticaria ("hives") and angioedema. which involves swelling under the skin. About 60 percent of people who have delayed pressure urticaria also get one or more of these other forms of hives.

Treating delayed pressure urticaria with drugs is problematic.
  • Antihistamines can help, but usually they don't work unless they are given in relatively high doses, three or four times the usual dose. This leads to corresponding side effects.
  • Steroids usually are not useful.
  • Aspirin, Tylenol, and Indomethacin, can make symptoms worse.
  • Steroids, especially Prednisone, can reduce the frequency of attacks and the severity of symptoms, but long-term use of steroids causes problems with a weakened immune system and weakened bones.
  • A drug called Dapsone, usually reserved for severe skin disease, sometimes gets good results in delayed pressure urticaria.
  • A kind of drug for heartburn (gastroesophageal reflux disease) called an H2 blocker sometimes helps relieve symptoms. These drugs include Axid (nizatidine), Pepcid (famotidine), Tagamet (cimetadine), and Zantac (ranitidine). These medications also help with the side effects of Aspirin and steroids.
  • A new medication called omalizumab shows promising results in clinical trials. It may be available in the US and EU in 2017.
It can take months of trial and error to find the best combination of medications to treat delayed pressure urticaria.

In the meantime, it is important to avoid the triggers for outbreaks. This isn't easy. The condition can be genuinely disabling.

The good news is that delayed pressure urticaria often simply goes away on its own. About one in four people who has the disease will "outgrow" it in five years. About one in two will no longer have symptoms after ten years. The average duration of symptoms is nine years. No one knows why the condition simply disappears, but it often eventually does.

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