A calendar and graphs representing the daily tracking method commonly used to assess hives severity

How Your Doctor Assesses the Severity of Chronic Hives

Doctors know that chronic hives are a type of long-term illness that lasts 6 weeks or more. Painful itching and swelling are 2 telltale signs of the disease. But what other factors help healthcare experts determine the severity of chronic hives?

Chronic hives features

Welts (also called wheals) are a common symptom of chronic hives. They are also clues for you and your doctor into how severe your illness is. Welts can:1

  • Impact any part of your body
  • Spread widely
  • Be different sizes
  • Appear discolored
  • Last minutes or hours
  • Change shape before healing
  • Come and go for 6 weeks or longer (chronic hives)

Chronic hives scoring system

Experts specializing in skin conditions have created a scoring system called the Urticaria Activity Score (UAS). It helps track day-to-day symptoms of chronic hives.

You will record your symptoms every day for 1 week using a 3-point scale. Each symptom – the number of welts and your itch level – will receive a score. A score of 0 means you are symptom-free, and 3 means you have severe symptoms. Here is a closer look at the scoring system:1

Score 0

  • You have no welts for 24 hours
  • You are itch-free

Score 1

  • You have fewer than 20 welts over 24 hours
  • You have mild itching

Score 2

  • You have 20 to 50 welts over 24 hours
  • You have moderate itching

Score 3

  • You have more than 50 welts over 24 hours
  • You have severe itching

After 7 days, you will add up your score, which will range from 0 to 42. You can then share this information with your doctor, who will suggest a treatment plan.

Chronic hives quality of life index

Chronic hives can impact your life beyond the disease itself. A quality of life index measures how chronic hives affect things like your sleep, work, and relationships. Doctors, nurses, and scientists use these indexes to assess and treat people living with certain health conditions.

There are two tools commonly used to measure the quality of life for people living with chronic hives:1-3

  • Dermatology life quality index
  • Chronic urticaria and quality of life questionnaire

Dermatology Life Quality Index (DLQI)

This 10-question survey measures a variety of different skin diseases, including chronic hives. It also compares chronic hives to other skin diseases like eczema and psoriasis.

The index asks how your illness impacts different facets of your quality of life over the course of 1 week. You will answer questions about your:

  • Symptoms
  • Feelings
  • Activities
  • Relationships
  • Treatment

Each question receives a score ranging from 0 to 3. A higher score indicates a poorer quality of life. The DLQI takes about 2 minutes to complete and is for people 16 years old and older.

Chronic Urticaria and Quality of Life Questionnaire (CU-Q2oL)

The CU-Q2oL survey focuses on chronic hives. It has 23 questions arranged into 6 categories related to the illness:

  • Itch
  • Swelling
  • Activities
  • Sleep
  • Barriers
  • Appearance

It also compares quality of life across different groups of people living with chronic hives. And the questionnaire monitors quality of life over time and with treatment.

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