Understanding Urticaria and Eczema: A Comprehensive Guide
- The London Allergy Clinic
- Jun 25
- 4 min read
What Is Urticaria?
Urticaria, commonly known as hives, is a skin condition characterised by raised, itchy welts (called wheals or lesions) that can appear anywhere on the body. According to the NHS, the rash can manifest as raised bumps or patches in various shapes and sizes. It may feel itchy, sting, or burn. On lighter skin tones, hives typically appear pink or red; on darker skin tones, the colour can be harder to see.
One of the most distinctive features of urticaria is its behaviour over time. Individual hive lesions typically come and go. They may appear for a couple of hours, then disappear completely, only to return elsewhere on the body later the same day or the following day. This pattern is a classic hallmark of urticaria. Importantly, when urticarial lesions resolve, they generally do so completely, leaving no marks, scars, or blistering on the skin.
Urticaria flare-ups typically last from a few hours up to a week at a time. It is very rare for an individual urticarial episode to last longer than a week. When urticaria persists or recurs over a period of more than six weeks, it is classified as chronic urticaria.
What Is Eczema?
Eczema, also called atopic eczema or atopic dermatitis, is a chronic inflammatory skin condition. Atopic eczema can make the skin itchy, dry, cracked, crusty, scaly, or thickened. The affected skin may appear red, white, purple, or grey, depending on the individual's skin tone. In some cases, the skin can blister or bleed.
Unlike urticaria, eczema typically presents with dry, flaky, or scaly skin—a key distinguishing feature. Dry and flaky skin is not a feature of urticaria, but it is strongly suggestive of eczema. Eczema symptoms tend to persist over time, with periods of flare-up and relative remission, rather than the come-and-go-within-hours pattern seen with hives.
Eczema commonly affects the elbows, knees, and hands. In babies and toddlers, it frequently appears on the face. Symptoms can start at any age, though they often begin in childhood and may improve over time. Eczema is not contagious.
Key Differences at a Glance
While both conditions cause itching, there are several important differences that can help you tell them apart:
Appearance: Urticaria appears as raised, smooth bumps or welts. Eczema appears as dry, flaky, scaly, or crusty skin that may be red and inflamed.
Duration: Urticaria lesions typically last a few hours and rarely more than a week per episode. Eczema is a chronic condition with persistent symptoms and periods of flare.
Skin texture: Dry, flaky skin points toward eczema, not urticaria. Hives are raised and smooth, not scaly.
After resolution: Urticaria lesions leave no trace when they go. Eczema-affected skin can remain thickened, discoloured, dry, or flaky.
Pattern: Urticaria comes and goes, potentially appearing and disappearing within hours. Eczema tends to be more persistent, often affecting the same areas repeatedly.
Treatment: Urticaria vs Eczema
The treatment pathways for urticaria and eczema are quite different, which is another reason it is important to get the right diagnosis.
Treating Urticaria
Antihistamines are the first-line treatment for urticaria. They work by blocking the effects of histamine—the chemical released in the skin that causes itching and swelling. The NHS advises that a pharmacist can recommend antihistamine treatment for hives, though this may not be suitable for young children or those with certain long-term conditions.
For chronic urticaria (lasting more than six weeks) that does not respond adequately to high-dose antihistamine therapy, a specialist may consider additional treatment options. These can include a short course of oral corticosteroids (steroids) to provide more rapid relief or, in appropriate cases, biological therapy. Omalizumab (Xolair) is a monoclonal antibody that is licensed for the treatment of chronic urticaria and may be considered in cases where antihistamines alone are insufficient.
Dr Arumugakani is a specialist in the use of Xolair for chronic urticaria.
Treating Eczema
Eczema has a completely different treatment plan compared to urticaria. The main treatments for atopic eczema are emollients (moisturising creams, lotions, ointments, and gels) and topical corticosteroids (steroid creams or ointments applied to the skin). Regular moisturising is a cornerstone of eczema management—applied at least twice daily, even during periods when the skin appears clearer.
Depending on the severity, additional treatments may include specialist dressings, immunosuppressant medications, or referral to a dermatologist. Antihistamines, which are the cornerstone of urticaria treatment, are not a primary treatment for eczema.
Who Can Help Me?
Because urticaria and eczema require different treatments and are managed by different specialists, getting the correct diagnosis is important.
If you think you may have urticaria, an allergy specialist is well-placed to help. At the London Allergy Clinic, we have extensive expertise in the assessment and management of urticaria, including chronic urticaria. Our team can confirm the diagnosis and guide you through the appropriate treatment pathway.
For eczema in adults, the primary specialist is a dermatologist.
However, if your child is affected by eczema, Dr Emily Derric at the London Allergy Clinic offers specialist paediatric assessment and is highly experienced in managing childhood eczema.
If you are unsure which condition you have, a consultation with a specialist is the best starting point. Early assessment can help you get the right treatment sooner.
Speak to a Specialist at The London Allergy Clinic
We offer specialist allergy consultations for adults and children at our clinics in Marylebone, Fitzrovia, and High Barnet. If you are concerned about urticaria, or if your child is affected by eczema, we are here to help.
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