Hives vs. Eczema: Identifying and Treating Skin Conditions

It can be difficult to tell apart hives and eczema. Both are itchy skin conditions that result from an immune system response. And they can look the same too. “Hives and eczema can cause the skin to look red and swollen. As a result, people may incorrectly refer to hives as eczema and eczema as hives,” says Brendan Camp, MDa board-certified dermatologist based in New York City.

That said, they all have different underlying causes, and there are ways to tell them apart just by looking at them. Here’s how to share what you’re dealing with and find relief.

Causes of hives and eczema

Hives and eczema are both essentially allergic skin conditions, but they all work a little differently. So let’s break it down.

Causes of hives

Hives (also called urticaria) is a rash that occurs when something irritates your skin. “They can develop in people as part of an allergic reaction to an environmental allergen, medication, food, or an underlying medical condition,” says Dr. Camp. They are very common: About 20 percent of people will develop hives at some point in their lives UpToDate.com.

That’s because hives can be caused by so many things. Here is a list of common culprits from the American College of Allergy, Asthma and Immunology (ACAAI):

• Foods, especially peanuts, eggs, tree nuts and shellfish
• Medications including antibiotics, aspirin and ibuprofen
• Insect stings and bites
• Physical stimuli, including heat, cold, pressure, exercise, or sun exposure
• Latex
• Bacterial or viral infections
• Pet dander
• Pollen
• Some plants
• Blood transfusions

Hives are usually short-lived and occur soon after you are exposed to an irritant and go away shortly afterwards. “Hives, by definition, do not last on the skin for more than 24 hours. They may disappear in one area and reappear in another, but a single hive lesion usually disappears within minutes to hours without leaving any trace,” says Dr . Camp.

Causes of eczema

Eczema (also called atopic dermatitis) is a condition that causes dry, itchy skin. It is thought to be caused by an overactive immune system that triggers the skin to mount an inflammatory response when it comes into contact with an allergen or irritant. National Eczema Association. “Eczema can occur in people with a genetic predisposition, characterized by reduced skin moisture retention and a compromised skin barrier,” says Dr. Camp.

Eczema is a chronic skin problem, but the allergens or irritants mentioned can cause an eruption. Again, there are a lot of possible culprits, but the National Eczema Association says some of the most likely culprits include:

• Dry air
• Extreme heat or cold
• Soaps, body wash products, bubble bath and other personal care products
• Aggressive detergents or cleaning agents
• Wool or polyester fabric
• Fragrances added, such as in scented candles
• Metals such as nickel, often found in jewelry or utensils
• Dust mites
• Tension

Eczema attacks last longer than hives. According to the National Eczema Association, it usually takes days or weeks for skin inflamed by eczema to calm down. There are also different types of eczema, the most common of which are atopic dermatitis, contact dermatitis, dyshidrotic eczema and hand eczema. American Academy of Dermatology (AAD).

Symptoms of hives vs eczema

Both hives and eczema make your skin red and itchy. But that’s kind of where the similarities end.

According to the ACAAI, hives:

• Are characterized by reddish bumps that appear suddenly and fade away. (An individual bump will disappear within 24 hours.) They may look pink on fair skin or purplish on dark skin.
• Itch
• Feels smooth
• Can appear anywhere on your body and can fade and appear in different places
• Turns white when you press the center

Eczema symptoms are quite different. According to the Mayo Clinicit causes:

• Swollen areas that may be red, pink or purplish
• Small raised bumps on dark skin
• Dry, cracked skin that feels rough to the touch
• Itch
• Seeping, crusting or crying

It can also be difficult to tell psoriasis and eczema apart. But psoriasis typically causes dry, raised patches of skin (called plaques) that look red or white and scaly Mayo Clinic.

Treatment for hives and eczema

Once you know what condition you’re dealing with (you can always consult your dermatologist or GP if you’re unsure), you can start looking at the right treatment. Sometimes it also involves home remedies for allergies, which may be causing your skin reaction.

Treatment for hives

First things first: If you can figure out what’s causing your hives, do what you can to avoid it, recommends Dr. Camp on. (If it is a medication, consult your doctor before stopping it.)

For quick relief, apply a cold compress, rub on an anti-itch lotion (such as calamine lotion), or take an over-the-counter antihistamine such as Zyrtec, Claritin, or Benadryl. They will take away the inflammation to relieve the redness, swelling and itching, says the AAD.

If your symptoms are severe or keep recurring, your doctor may recommend a corticosteroid such as prednisone or a prescription antihistamine. If those don’t cut it, an injectable biologic such as omalizumab can help, the AAD notes.

Treatment for eczema

Prevention is the best medicine when it comes to eczema. That starts with preventing your skin from becoming too dry, which can lead to irritation. “Maintaining a simple skin care routine focused on providing adequate skin moisture is essential,” says Dr. Camp. This includes taking short showers or baths (long showers dry out your skin) and then applying a thick ointment or cream (apply throughout the day if you feel dry), the National Eczema Association recommends.

You need more help when you’re flaring. Cold compresses can soothe mild symptoms, but generally “flares can be treated with topical steroids or oral medications such as steroids or antibiotics,” says Dr. Camp. If your eczema is severe, your doctor may prescribe an injectable biologic or an oral immunosuppressant (such as a JAK inhibitor) to control your symptoms, according to the American Academy of Allergy, Asthma and Immunology.

Preventing hives and eczema

You can’t always stop hives or an eczema flare-up, TBH. But being kind to your skin and avoiding triggers as much as possible makes a big difference for both of you.

According to the ACAAIADA, and Cleveland Clinicthese things can help:

• Wear loose, comfortable cotton clothing: Tight clothing makes it harder for your skin to breathe. Especially with eczema, you should avoid irritating fabrics such as wool or polyester.
• View the temperature: On hot, sticky days, try to stay cool and in the shade; Overheating and too much sun can cause eczema or hives. Keep your skin covered even if you are in cold or windy conditions.
• Don’t let your skin dry out: This one is mainly for eczema. Again, keep those showers or baths warm (not hot) and short (think five to ten minutes max), and be religious about moisturizing.
• Resist the urge to rub or scratch: Both irritate your skin and can make the problem worse.
• Identify your triggers and avoid them: Everyone’s skin reacts differently to different triggers. Keep a diary of your symptoms and the details of how they started (Did your hives start after eating shrimp? Did your eczema flare up after a day at the beach?) to figure out what’s causing your skin to irritate so you can limit your exposure as much as possible.

When should you consult a doctor?

You usually don’t have to worry about a one-time case of hives that goes away quickly. But if your symptoms persist and get worse over time, definitely seek help. See a dermatologist if your skin doesn’t respond to at-home or over-the-counter treatments, or if your rash is negatively affecting your quality of life, advises Dr. Camp. Together you can come up with a plan to control the itching and feel better.

FAQ

Can stress cause hives or eczema?

Absolute. “Stress can worsen the symptoms associated with hives and eczema, especially itching. Stress can also trigger the itch-scratch cycle, which can worsen symptoms and put the skin at increased risk for infection,” says Dr. Camp.

On the other hand, finding ways to tame your tension can help keep your skin calm. You can usually tell stress hives from eczema if the rash disappears completely once you relax/once the trigger is gone.

How can you tell the difference between hives and contact dermatitis?

Differences in rashes can be difficult to pinpoint. Two important things to pay attention to? First, pay attention to the texture. Hives are smooth, while eczema is rough and scratchy. Second, see how long your symptoms last. Although a case of hives can last a few days or longer, a single hive will disappear within 24 hours, says Dr. Camp. (Circle it with a marker so you can keep track!) Eczema attacks usually last days or weeks. It is also possible to get hives that are not itchy, while contact dermatitis is likely to always itch.

Can you get eczema or hives as an adult?

Eczema often develops in childhood, but can also develop in adulthood, especially in your 50s. Eczema in adults is more common on the back of your knees, elbow bends, back of the neck, face or around the eyes, notes the AAD.