NY Dermatologist Joshua Fox, MD, Offers Tips on Treatment Options for Acute and Chronic Hives Today


NY Dermatologist Joshua Fox, MD, Offers Tips on Treatment Options for Acute and Chronic Hives Today

Understanding the Connection Between Stress and Hives

Roslyn, NY – January 15, 2013

New studies currently underway may help pinpoint connections between chronic idiopathic urticaria (hives caused by an unknown source) and stress, good news for the majority of patients whose hives have no clear cause. Researchers are examining the connections between major life stressors and hives, post-traumatic stress disorder and hives, and the effect of hypnosis and relaxation techniques on hives. “When you stop to consider that the skin and nervous system develop from the same embryonic layer, it makes sense that stress can affect the skin,” said dermatologist Joshua Fox, M.D., medical director of Advanced Dermatology PC. “We already know, for example, that stress can promote hair loss and exacerbate skin conditions such as acne, eczema, psoriasis and rosacea.”

Hives are raised red or white welts that vary in size; appear anywhere on the body (including inside the mouth); cover all or parts of the body; cause itching, burning or stinging; while each individual hive does not last more than 24 hours, the condition can last from a few hours to six weeks (acute) or longer than six weeks (chronic). According to Dr. Fox, “they can rarely be life threatening, requiring immediate medical attention, particularly when they cause swelling in the throat. Fortunately hives are typically treatable.”

In non-emergent situations, a dermatologist can work closely with a patient to determine if the hives are caused by food (milk, soy, eggs, nuts, shellfish and wheat are top culprits, along with additives and preservatives), medications (pain killers, antibiotics and blood pressure medications in particular), external stressors (exercise, water, sun exposure and extreme temperatures), and internal stressors (infection, illness and autoimmune disorders, liver disease, and allergic reaction to donor blood). Hives will sometimes disappear on their own without treatment, but when they don’t, dermatologists can help patients find the right medication or combination of medications to treat the condition.

Diagnosing Hives
A visual inspection is often all a dermatologist needs to diagnose hives; it’s pinpointing the cause of the hives that requires medical sleuthing. In addition to reviewing a patient’s health history and completing a physical, a dermatologist may conduct allergy tests (skin patch test or blood), blood work (to rule out illness) and/or skin biopsies. Once the root cause is understood, treatment may begin and may include over-the-counter or prescription medications, or a combination of medications. Sometimes a dermatologist may also need the services of an allergist to scratch test the patient.

Treating Hives
Antihistamines work to control symptoms by blocking the body’s release of histamines in response to an allergen. There are newer (second generation) and older (first generation) antihistamines, prescription and over-the-counter, and sometimes a combination will give the patient the best results. Antihistamines don’t treat the cause, only the symptoms.

Second-generation antihistamines are usually attempted first, since they are typically as effective as first-generation antihistamines, and better tolerated as they generally cause minimal sedation or tiredness. Some examples are Loratadine (Claritin, Alavert), Fexofenadine (Allegra), Cetirizine (Zyrtec), Levocetirizine (Xyzal) and Desloratadine (Clarinex).

First-generation antihistamines may be prescribed when non-sedating second-generation drugs don’t work. Because these drugs can cause drowsiness, and impair one’s ability, they are often taken before bedtime. Examples include Hydroxyzine (Vistaril), Diphenhydramine (Benadryl) and Chlorpheniramine (Chlor-Trimeton).

When antihistamines don’t relieve symptoms:
H-2 antagonists. Cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid AC) are sometimes used with antihistamines, but can cause side effects ranging from gastrointestinal problems to headache.

Corticosteroids. While topical corticosteroids are typically ineffective, oral corticosteroids such as prednisone can provide relief from the uncomfortable symptoms of severe hives by reducing swelling, redness and itching, but can’t be taken long term due because of the serious side effects they occasionally cause, such as weakening the immune system and promoting glaucoma, cataracts, ulcers, weaker bones and high blood pressure. Often the hives may return when stopping the corticosteroids.

Tricyclic antidepressants. Doxepin’s (Zonalon) antihistamine properties can relieve itching, but they also cause dizziness or drowsiness and other side effects. There are additional effective medications with more side effects.

When a physical or systemic cause is not evident, and indicators point to stress as a possible cause for hives, it’s still important to confer with a dermatologist. “Desperation may lead a patient to try anything and everything to cure hives,” said Dr. Fox, “but with guidance from a dermatologist, a patient can instead approach the process in a systematic fashion.”

Researchers are currently studying if hives can be lessened by hypnosis and other relaxation techniques; hypnosis has been shown to help patients suffering from psoriasis, warts and hair loss, and meditation, biofeedback and talk therapy have been shown to help psoriasis.



Leading dermatologist explains how stress can wreak havoc on your skin

New York, NY, July 2008 – Stressed out? You might find yourself pigging out on sugary snacks, snapping at your kids or lying awake half the night. And it will show on your skin because stress can lead to skin problems, as well. “We know that stress can have a dramatic effect on the immune system,” says Joshua Fox, MD, founder of Advanced Dermatology and a spokesman for the American Academy of Dermatology. “And quite often, that can create immune-related responses in the skin.”

Everyone faces stress, and we’re all familiar with the theory of “fight or flight,” which explains how our ancestors were able to survive the life-and-death stresses that they encountered. The stress response puts your whole body into high gear, boosting the systems that would help you face a physical threat and suppressing functions that aren’t essential at the moment (this includes the immune system). Once the crisis has passed, everything goes back to normal.

Unfortunately, the psychological “threats” that most of us face today are ongoing, meaning they trigger a never-ending stress response. The body gets stuck in fight-or-flight mode — and all those systems that were temporarily suppressed can stay that way. “In today’s world, the physiological changes that are part of the stress response get misrouted,” Dr. Fox explains. “Instead of helping you attack or run away, they’re triggering inflammatory, autoimmune or allergic reactions.”

Studies have shown that psychological stress can create problems such as acne, hair loss, eczema, psoriasis and rosacea. For example, a study of college students showed that acne got markedly worse at exam time. Other studies show that stress leaves skin open to infection. “Stress seems to disrupt the skin’s antimicrobial barrier and reduce the production of chemicals necessary for the synthesis of fats,” Dr. Fox explains. “That means stressed-out skin loses its ability to defend and rebuild itself.”

If you think stress might be causing problems in your skin, see your dermatologist. And consider stress-relieving tactics, which have been shown to help alleviate some skin problems. “We don’t fully understand the biological mechanisms that might be involved, but we know that relaxation does improve your outlook and helps you do things — like eating healthier food, sleeping better and getting more exercise — that improve the health of your skin,” Dr. Fox says.

Here are a few to try:

Meditation. Research shows that psoriasis patients who listened to meditation tapes while receiving ultraviolet light treatments healed much faster than patients who did not use the tapes.

Biofeedback. In one published study, a 56-year-old woman who had suffered from severe psoriasis for several years (and had no luck with standard medical treatments) was cured after 13 weeks of biofeedback therapy.

Hypnosis. One study found that psoriasis patients who were susceptible to hypnosis treatments improved more than patients who resisted hypnosis. Hypnosis has also helped get rid of warts and cure hair loss (in one study, 57 percent of patients had total or partial hair regrowth after undergoing hypnosis).

Talk therapy. It’s been estimated that as many as 60 percent of people who seek treatment for skin problems also have emotional issues, and we know that anger, depression and anxiety all affect the immune system. “Being aware of what’s stressing you can help your overall health — and your skin,” Dr. Fox says.

Relief for a stubborn side effect of stress.


Relief for a stubborn side effect of stress.

An estimated 25 million American women battle the confidence-draining effects of dandruff, spending millions each year to remedy the problem. “Dandruff occurs when underlying factors-such as stress or a fungal overgrowth-cause scalp cells to die and flake off at an accelerated rate,” explains Diana Bihova, M.D., a dermatologist in New York City “Commercial treatments may work well at first, but over time they become less effective. To defeat dandruff for good, you must treat the core causes.” Here, the proven strategies that will help any woman restore scalp health and self-confidence.
Stop stress hormones with this vitamin
Stress triggers the production of corticotropin-releasing hormone and adrenaline, two compounds that boost the secretion of sebum, a natural lubricant that makes the scalp susceptible to dandruff says Joshua Fox, M.D., of’ Advanced Dermatology P.C. and The Center for Laser and Cosmetic Surgery in New York. Chronic stress also depletes the body’s stores of vitamin B6, a vital component of healthy skin and scalp cells and a key player in the production of serotonin, a calming brain chemical. So simply maintaining healthy levels of B6 serves double duty in the fight against flakes. To ensure an adequate intake, Dr. Fox recommends consuming 2 mg of B6 daily (Good sources include tuna (1.2 mg per 4 oz. serving), bananas (.7mg each) and avocados (.3mg each).

Decrease flaking by 41% with tea tree oil
University of Pennsylvania researchers have discovered that dandruff sufferers harbor 28 percent more of the fungus pityrosporum ovale than flake-free subjects. To the rescue: tea tree oil. “It’s rich in terpenes, compounds that have proven antifungal powers,” explains Tim Schwaiger, N.M.D., of Southwestern Naturopathic Medical Center in Arizona. In fact, lathering daily with a 5 percent tea tree oil shampoo was shown to decrease flaking and itchiness by 41 percent. (Try Nature’s Gate Tea Tree Oil Shampoo, $8 for 18 oz.; at nutritionblvd.com.)

Reduce inflammation by 62% with aloe vera
Dandruff and an itchy scalp go hand in hand, but scratching only increases inflammation and flaking. To stop the cycle, choose a conditioner with aloe vera: It contains acemannan, a compound with anti-inflammatory and antimicrobial action that reduces dandruff-related inflammation by 62 percent, according to a Journal of Dermatological Treatment study. (Try Mill Creek Aloe Vera Conditioner, $6 for 16 oz.: at nutritionblvd.com.)