COVID-19 infection can manifest in ways beyond respiratory symptoms, and for some, a skin rash is an early indication of illness. The appearance of raised, itchy welts, known as urticaria or hives, is a temporary immune response to the SARS-CoV-2 virus. These skin reactions reflect the body’s generalized inflammatory state as it fights the infection. Understanding the nature and expected duration of COVID-19 hives helps people manage the symptom during recovery.
What Are Hives Related to COVID-19?
Hives are characterized by the sudden appearance of intensely itchy, raised patches on the skin called wheals or welts. These bumps can be pink, red, or skin-colored. They are migratory, meaning they can appear, fade, and reappear in different areas of the body within hours. COVID-related urticaria commonly affects the torso, back, arms, and legs, ranging in size from small spots to large interconnected areas.
This skin manifestation results from the immune system’s reaction to the virus. Immune cells, known as mast cells, are activated within the skin’s dermal layer. This activation triggers the release of chemical mediators, such as histamine. Histamine causes local blood vessels to widen and leak fluid, resulting in the characteristic swelling and itchiness of the wheals. Hives can appear at any point during the illness, sometimes preceding typical COVID-19 symptoms like fever or cough, or emerging later.
The Typical Timeline of COVID-Related Hives
Most cases of COVID-19 associated hives are classified as acute urticaria, meaning they resolve relatively quickly. The typical duration for this rash is short-lived, often lasting around seven to twelve days. Hives usually resolve as the body clears the active viral infection, with some studies noting an average duration of just under seven days.
While most people experience a brief episode, the duration can vary widely. Hives persisting beyond two weeks following the initial infection may indicate a prolonged course. The body’s continued inflammatory state or an autoimmune reaction can sometimes trigger chronic spontaneous urticaria (CSU). CSU is defined as the recurrence of hives for six weeks or more.
Cases of chronic urticaria following COVID-19 are rare, but they may last for many months. The mean duration of chronic hives triggered by the infection has been reported to be over a year in some documented cases. Urticaria that starts more than two weeks after the initial COVID-19 symptoms may indicate this prolonged chronicity.
Management and When to Contact a Healthcare Provider
Management of COVID-19 hives focuses on relieving intense itching and discomfort until the rash resolves naturally. Over-the-counter H1 antihistamines, such as loratadine or fexofenadine, are the primary treatment strategy. They work by blocking the histamine released by the activated mast cells. Applying cool compresses to the affected areas provides immediate, soothing relief and helps reduce localized swelling.
Soothing topical treatments include calamine lotion or cool baths infused with colloidal oatmeal. It is important to avoid scratching the welts, as this can further irritate the skin and potentially lead to secondary infections. If the hives are severe or do not respond to standard antihistamine doses, a healthcare provider may recommend a short course of oral corticosteroids.
Contact a healthcare provider immediately if the hives are accompanied by severe or concerning symptoms. These warning signs include swelling of the lips, tongue, face, or throat, known as angioedema. Difficulty breathing or wheezing requires immediate emergency medical attention, as these are signs of anaphylaxis. Consultation is also necessary if the hives persist beyond six weeks, meeting the definition of chronic urticaria, or if the itching interferes with sleep or daily life.