Urticaria after Covid-19, how to treat?

A large number of Covid-19 patients, after recovering from the disease, still have post-Covid-19 problems (also known as persistent Covid-19 syndrome). This not only affects health but also affects psychological factors, thereby reducing the quality of patients. Common are urticaria and skin rash.

Currently, many patients after being infected with Covid-19 have experienced persistent symptoms, even having to return to the hospital for treatment. Research results show that 33%-76% of patients may experience post-Covid-19 symptoms lasting at least 6 months after infection.

The World Health Organization (WHO) has published the first official definition of the Post-Covid-19 Syndrome. Accordingly, the post-Covid-19 condition occurs in people with a history of infection with symptoms and lasts at least 2 months that cannot be explained by an alternative diagnosis.

This condition can cause long-term deterioration in a person's health, having a serious impact on their ability to return to work or participate in social life. Post-Covid-19 affects physical mental health and can have significant economic consequences for individuals, families and society.

1. Why did the locket appear after Covid-19?

There are about 200 symptoms associated with Post-Covid-19 Syndrome, especially in patients who have undergone intensive care. People infected with Covid-19 for many weeks to months after recovering from the disease still face a series of symptoms and lasting sequelae such as low-grade fever, difficulty breathing, prolonged cough, fatigue, muscle and joint pain, hair loss, etc. pulmonary fibrosis, heart palpitations or palpitations, digestive disorders (loss of appetite, loss of appetite, stomach pain, diarrhea.), taste or smell disturbances. In which, the majority of cases encountered the symptoms of urticaria.

The majority of post-Covid-19 cases experience symptoms of urticaria.

Urticaria with skin lesions are edematous papules surrounded by a red, very itchy halo. The papules can persist for 30 minutes to 36 hours, range in size from 1 mm to several centimeters (giant urticaria), and lose color when pressed. Urticaria is characterized by dilated blood vessels and increased permeability. Urticaria may or may not be accompanied by angioedema, with the main manifestation being swelling, red or normal skin above, little itching but pain and burning.

Urticaria is generally classified into 2 main groups:

1. Acute urticaria when the duration is less than 6 weeks
2. Urticaria is chronic when it persists and recurs for longer than 6 weeks.

The appearance of raised erythematous plaques on the skin surface is thought to be due to increased sensitization of plasma cells (mast cells) causing the release of histamine and other chemical mediators such as leukotrienes, cytokines, chemokines leading to increased vascular permeability and swelling of the skin tissue and vasodilation causing the skin to become red.

Previously, it was thought that hives on the skin were caused by drugs to treat Covid-19. But, many reported cases of the condition preceded the use of the drug. However, the opinion of many scientists is that post-Covid-19 urticaria is the result of acute systemic inflammatory reactions when infected with SARS-CoV-2, causing the release of pro-inflammatory cytokines and cell activation. mast cells.

2. How to treat post-Covid-19 urticaria appropriately?

It should be noted that the urticaria mentioned in this article is a common symptom experienced during and after the Covid-19 phase. Therefore, Covid-19 treatment is still the foundation and patients need to comply to quickly recover from the disease.

According to information from the American Academy of Dermatology, hives in Covid-19 patients can last from 2 to 12 days. On average, most people have it for 8 days. However, the effects on the toes can last from 10 to 14 days. If the above time is exceeded, the patient can refer to some specific treatment below.

2.1. Non-drug treatment

1. Stop all drugs or foods suspected of causing an allergic reaction.
2. Avoid scratching and rubbing vigorously on the skin.
3. Can apply cold or cold shower, avoid hot bath.
4. Avoid direct sunlight.
5. Deworming, anti-constipation.
6. Wear lightweight, well-fitting cotton clothing.
7. Avoid strenuous activities or causes that cause sweating.
8. Try to rest and reduce stress.
9. Avoid scratching or rubbing the skin.

Avoid scratching or rubbing the skin.

2.2. Treatment with drugs

Antihistamines group

Antihistamines are divided into two generations:

1. First generation (diphenhydramine, chlorpheniramine, hydroxyzine)
2. Newer second generation (cetirizine, loratadine, fexofenadine)

Second-generation drugs are preferred for both adults and children because of fewer side effects and lower dose requirements than first-generation drugs. Treatment with an H1 antihistamine helps reduce swelling and relieve itching.

Cetirizine is fast acting and stabilizes mast cell activity. The drug also causes mild sedation when administered in relative doses. It is available for injection and oral in the same dosage for both routes of administration. The injection route is suitable for adults and children 12 years of age and older. For children, it is important to use the correct dose. Caution should be exercised when administering maintenance doses to patients with renal or hepatic impairment.

Levocetirizine is an isotope that is as active as cetirizine but requires only a smaller dose (about half). However, levocetirizine is not a substitute for patients who have failed to respond to cetirizine. The drug has a side effect of sedation similar to that of other second-generation antihistamines. Dosage should be reduced in patients with renal impairment.

Loratadine is a selective and long-acting H1 antihistamine. For patients with kidney or liver failure, it should be taken every other day.

Fexofenadine is used to treat urticaria in adults and children over 6 years of age.

Common side effects are headache, nausea, and dizziness. It is better not to take the medicine with meals and especially not with fruit juices.

Glucocorticoids (such as prednisolone) do not inhibit the release of mast cells, but do inhibit the activity of inflammatory responses. The drug has a lot of side effects, so it is only used in the treatment of acute, severe urticaria or some cases of urticaria caused by vasculitis, due to pressure not responding to conventional antihistamines. Not recommended for the treatment of idiopathic chronic urticaria.

3. Doctor's advice

1. Do not self-medicate without consulting your doctor.
2. When a Covid-19 patient develops urticaria, it is necessary to simultaneously monitor other symptoms. If urticaria comes on suddenly and spreads or occurs concurrently with fever, pain, blistering, signs of infection such as swelling, oozing of pus, signs of respiratory distress such as rapid breathing, difficulty breathing, SpO2 decreased < 94% requiring hospital follow-up.

Stop taking the medicine immediately and contact your doctor if you experience serious side effects such as swelling of the face, lips, or tongue, or difficulty breathing, swallowing, unusually fast heartbeat, severe dizziness.