Generalized Urticaria: A Case in Early 50s Menopause

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"When my body gets hot, hives appear, and it's gotten worse recently..."

A patient in her early 50s has been suffering from generalized urticaria appearing on her body for the past few months. Initially, it was an occasional symptom, but now hives appear three to four times a week or more, lasting one to two hours each time. Her skin becomes red and swollen, and the itching is severe. The symptoms tend to worsen when her body gets hot.

Although taking antihistamines when hives appeared provided some relief, she became increasingly concerned as the medication's effectiveness seemed to diminish recently. She visited our Korean Medicine Clinic feeling that her overall health had deteriorated, especially with accompanying menopausal symptoms such as stiff joints, heart palpitations, and hot flashes.

The Connection Between Generalized Urticaria and Menopause

Urticaria

Urticaria is a condition that occurs when the skin overreacts to certain stimuli. In this case, it has become chronic, persisting for more than three months.

Major Causes of Generalized Urticaria

• Cholinergic Urticaria: A type of urticaria that appears on the skin when the body temperature rises, commonly occurring during showers, baths, or exercise.
• Stress: Psychological stress often exacerbates urticaria.
• Immune System Dysfunction: Chronic urticaria can be associated with autoimmune reactions, and there's a possibility it's linked to the patient's menopausal symptoms.

The Relationship Between Menopause and Urticaria

Menopause is a period when the body's immune system and neuroendocrine system become unstable due to decreased estrogen. As a result, the following symptoms may appear alongside urticaria:

• Hot Flashes and Flushing: Skin is likely to become hypersensitive due to changes in body temperature.
• Joint Stiffness: Inflammation-related immune responses may increase.
• Increased Stress Sensitivity: Psychological instability can trigger autonomic nervous system responses such as urticaria.

Treatment Plan: An Integrated Approach with Herbal Medicine and Acupuncture

Korean medicine treatment aims to reduce the frequency and intensity of urticaria and improve the overall constitution related to menopausal symptoms, proceeding with a combination of herbal medicine and acupuncture.

1. Herbal Medicine Treatment

After a thorough diagnosis of the patient's constitution, symptoms, and body condition, a prescription was formulated considering her constitution and medical history.

• Restoring Immune Balance: 'Cheongyeol Haedok-yak' (heat-clearing and detoxifying herbs) and 'Boik-yak' (tonifying and replenishing herbs) are used to regulate autoimmune reactions that can cause urticaria and reduce skin hypersensitivity. Representative herbs may include Hwanggeum (Scutellaria baicalensis), Saengjihwang (Rehmannia glutinosa fresh root), and Sukjihwang (Rehmannia glutinosa prepared root).
• Alleviating Menopausal Symptoms: Prescriptions that help tonify blood ('boyeol') and qi ('bogi'), such as Gyeopbitang (Guipi-tang) and Palmultang (Ba-wu-tang), may be utilized to improve hot flashes, joint stiffness, and fatigue caused by menopause.
• Stress Regulation: Herbs that alleviate stress and stabilize nerves are also added. Sanjoin (Ziziphus jujuba seed) and Baekchul (Atractylodes macrocephala) have calming effects on the mind.

2. Acupuncture Treatment

Acupuncture treatment aims to simultaneously relieve urticaria symptoms and improve menopausal symptoms.

• Acupoints for Urticaria Symptom Relief: Quchi (LI11), Zusanli (ST36), Hegu (LI4): These points inhibit inflammatory reactions and reduce skin hypersensitivity. Dazhui (GV14), Fengchi (GB20): These points enhance body temperature regulation and immune function.
• Acupoints for Menopausal Symptom Relief: Sanyinjiao (SP6), Taixi (KI3): Effective in regulating hormonal balance and reducing hot flashes and flushing. Shenshu (BL23), Ganshu (BL18): These points strengthen the functions of the liver and kidneys, promoting overall stability in the body.

3. Lifestyle Management

The following lifestyle adjustments were recommended to the patient to manage her urticaria and menopause:

• Temperature Regulation: Avoid excessive exercise to prevent overheating, and use soothing moisturizers after warm showers to calm the skin.
• Dietary Adjustments: Avoid allergenic foods that can trigger urticaria (e.g., spicy foods, alcohol, caffeine), and maintain a diet that strengthens immunity.
• Stress Management: Reduce stress through light yoga or meditation, and ensure sufficient sleep.

Since starting treatment, the frequency and intensity of urticaria have significantly decreased. Hives, which previously occurred 3-4 times a week, have gradually reduced to 1-2 times a week, and even when symptoms appear, they often disappear within 30 minutes. A gradual reduction in the frequency, intensity, and duration of urticaria, leading to improvement, can be considered a typical course of treatment. In this case, treatment also considered menopausal symptoms, and the patient reported feeling less body stiffness and hot flashes.

How to Manage Urticaria and Menopausal Symptoms Together?

• Address the Root Cause: Chronic urticaria is not merely a skin condition but is often related to an imbalance in the immune system and neuroendocrine system. Constitutional improvement is essential.
• Maintain Appropriate Lifestyle Habits: It is important to adopt lifestyle habits that reduce temperature changes and stress, and avoid triggers for urticaria.
• Seek Systematic Help: When symptoms become chronic, it's difficult to resolve them alone. Integrated approaches like herbal medicine and acupuncture can be greatly helpful in alleviating both urticaria and menopausal symptoms simultaneously.

If you are struggling with generalized urticaria and menopause, try treatments that focus on rebalancing the entire body rather than just addressing the symptoms. Through consistent management and treatment, you can regain a healthy and comfortable daily life!