If you’ve ever had an allergic reaction that triggered itchy hives anywhere on your body, you know how uncomfortable it can be. Imagine, for a moment, that something as benign as using a loofah in the shower or rubbing your body dry with a towel could trigger chronic hives to come to the surface. While this condition can be frustrating and impact quality of life, it is often self-limited over time, with effective treatments available. We spoke with several dermatologists about this condition, its triggers and available treatment options.
Featured experts
- Anna Chacon, MD is a board-certified dermatologist in Miami
- Dr. Shereen Teymour is a board-certified dermatologist in New York
- Dr. Payvand Kamrani is a board-certified dermatologist in Chapel Hill, NC
What are chronic hives?
Chronic hives are most commonly diagnosed as chronic spontaneous urticaria (CSU). “This condition is defined by hives that recur for six weeks or longer without a consistent external trigger. It is driven by overactive mast cells in the skin, which release histamine and lead to itchy, raised welts that appear and resolve unpredictably,” explains Miami dermatologist Anna Chacon, MD. In many cases of CSU, there is an autoimmune component, where the body triggers its own allergic-type response. Another type of chronic hives is called chronic inducible urticaria (CIndU), where hives are triggered by outside stimuli, such as pressure, friction, heat, cold or exercise.
“At the cellular level, hives occur when mast cells in the skin become activated and release histamine and other inflammatory mediators. This causes blood vessels to dilate and become more permeable, producing the characteristic raised, red or skin-colored, intensely itchy welts,” explains New York dermatologist Dr. Shereen Teymour.
It’s also important to dispel the misconception that chronic hives automatically mean that someone has an unidentified allergy. “Unlike an acute episode of hives after eating a specific food, chronic spontaneous urticaria is usually not caused by a food or environmental allergy. In many patients, there appears to be an autoimmune component in which the immune system inappropriately activates mast cells,” explains Dr. Teymour.
The skin interactions that can trigger chronic hives
Several everyday skin interactions can provoke hives, especially in sensitive individuals.
Friction
The most common trigger is friction on the skin, also known as dermographism. “This is actually diagnosed by a dermatologist by placing a fingernail drawn across the back, leaving a raised welt within minutes,” explains Chapel Hill, NC dermatologist Dr. Payvand Kamrani. These raised welts can be caused by clothing or skin contact from bra straps, waistbands, backpack straps or seatbelts. Additionally, shaving, vigorous towel-drying, exfoliating with a scrub or loofah or even a firm massage can be enough to trigger a reaction.
Heat and sweat
Heat and sweat are another cause of chronic hives called cholinergic urticaria. Hives can be caused by a rise in core body temperature from hot showers, exercise or hot yoga, which can lead to hives, most commonly on the legs. Conversely, cold exposure, including cold air or water, may also provoke a reaction in some individuals.
Pressure on the skin
Pressure on the skin, such as prolonged sitting or carrying heavy bags, can lead to delayed hive formation.
Products and preservatives
Certain allergens, for example products or preservatives, can also cause chronic urticaria, called contact urticaria. “Topical agents produce welts within 15 to 30 minutes of application, including balsam of Peru, cinnamic acid, benzoic and sorbic acid preservatives and latex,” says Dr. Kamrani.
How can chronic hives be treated?
“The first step is identifying which type of chronic urticaria someone has and, when possible, minimizing predictable triggers without making someone afraid to interact normally with their skin,” says Dr. Teymour. Next, doctors recommend non-drowsy antihistamines like Zyrtec, Allegra or Xyzal. “Sometimes the dose on the box is often not enough for chronic hives, and dermatologists routinely go higher, sometimes up to four times that amount,” explains Dr. Kamrani.
For patients whose symptoms persist despite antihistamine use, “there are now three prescription medications approved specifically for chronic spontaneous urticaria: Xolair and Dupixent, both injections, and Rhapsido, which was approved in late 2025 and is the first pill of its kind for chronic hives,” says Dr. Kamrani.
Beyond medication, small daily changes can help to minimize chronic hives, including taking lukewarm showers instead of scalding ones, wearing looser clothing, keeping your skin moisturized, avoiding known triggers and using only fragrance-free products.
