Nighttime Hives and COVID-19: Understanding Causes and Skin Symptoms

Hives, also known as urticaria, are a frequent skin reaction linked to COVID-19 infection and can occur at any time, including both day and night. When hives appear exclusively at night, it often points to specific triggers encountered during evening hours.

COVID-19-related hives commonly emerge early in the infection and may even be the initial sign of the virus. These skin manifestations, including rashes and hives, usually resolve quickly but can persist for months in some cases.

Hives develop when the immune system releases histamine in response to allergens or infections. While COVID-19 can cause hives, allergic reactions to foods, medications, or topical irritants are more frequent culprits.

This article delves into the connection between hives and COVID-19, discusses why nighttime-only hives occur, and offers guidance on managing these skin conditions.

Link Between Hives and COVID-19

Studies have established that hives are among the common skin symptoms associated with COVID-19. A 2023 review analyzing 63 studies found that hives typically coincide with other COVID-19 symptoms such as fever and cough, lasting on average nearly a week.

Additionally, some COVID-19 treatments themselves may provoke hives. Further research is ongoing to clarify the mechanisms behind coronavirus-induced hives.

Early pandemic data showed that approximately 9% of COVID-19 patients developed hives, although skin symptoms may be underreported due to their early appearance before more recognizable signs.

Why Do Hives Appear Only at Night?

While hives can fluctuate throughout the day, those appearing solely at night are usually linked to allergens or irritants encountered in the evening. Common nighttime triggers include laundry detergents on bedding, skincare products applied before sleep, or medications taken at night.

Another cause of nocturnal hives is alpha-gal syndrome, a condition triggered by tick bites that leads to allergic reactions to red meat and other animal products. These reactions often develop hours after consuming meat or gelatin-containing medications.

Common Nighttime Hives Triggers

• Detergents on clothing or bedding
• Nighttime lotions or creams
• Medications taken before bedtime
• Stress and anxiety
• Pressure from tight clothing or prolonged contact with surfaces
• Temperature changes such as cold air, sweating, or hot showers
• Environmental allergens like dust mites, mold, pollen, or pet dander

Other Skin Manifestations of COVID-19

COVID-19 can cause various rashes and skin conditions, with prevalence estimates ranging from 4% to over 20%. A 2023 literature review identified six primary rash types linked to the virus.

Maculopapular Rash

This itchy rash features both flat and raised areas, often appearing on the torso but potentially anywhere on the body. It may precede or follow other COVID-19 symptoms and typically lasts 8 to 12 days.

Chilblain-like Lesions

Known as "COVID toes," these cause swelling and redness mainly on toes and sometimes fingers, predominantly in younger individuals. They usually appear later in the illness.

Vesicular Rash

Characterized by blister-like spots, this rash is more common in middle-aged adults and emerges about two weeks after initial symptoms, resolving within 8 to 10 days.

Petechiae

These small red, purple, or brown pinpoint spots may appear on the torso and limbs but are less common with COVID-19.

Livedoid Eruptions

A rare net-like rash that appears alongside other symptoms and lasts around nine days.

Effective Home Remedies for Hives

Though hives can be uncomfortable, several home treatments can alleviate symptoms. Most hives resolve within hours, but while present, consider:

• Applying over-the-counter anti-itch lotions such as calamine
• Using cold compresses to soothe affected areas
• Taking antihistamines or allergy medications as directed
• Moisturizing with fragrance-free creams to reduce irritation
• Practicing stress management techniques to prevent flare-ups
• Keeping a diary to identify potential triggers
• Wearing loose, breathable clothing to minimize pressure

When to Consult a Healthcare Professional

Occasional hives often respond well to home care, but persistent or recurrent hives lasting more than six weeks warrant medical evaluation. The American Academy of Dermatology advises seeing a board-certified dermatologist, allergist, or primary care provider for diagnosis and management.

Doctors may perform allergy testing or other assessments to identify the underlying cause and exclude serious conditions.

Summary

COVID-19 can induce various skin reactions, including hives that may appear early in the infection and fluctuate throughout the day. Nighttime-only hives are more commonly due to allergens or irritants encountered in the evening rather than COVID-19 itself.

Identifying triggers and using appropriate treatments like antihistamines and topical creams can help manage hives effectively. Persistent cases should be evaluated by a healthcare professional to ensure proper care.

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