What are hives and how do they manifest on the skin. What triggers hives and how can they be effectively treated. How to distinguish hives from other skin conditions and when to seek medical help. What are the long-term management strategies for chronic hives.

Understanding Hives: An In-Depth Look at Urticaria

Hives, medically known as urticaria, are a common skin condition characterized by red, raised, and itchy bumps on the skin. These welts can vary in size, from small spots resembling mosquito bites to large patches spanning several inches. Affecting approximately 20% of the population at some point in their lives, hives can be a source of discomfort and concern for many individuals.

Are hives a serious medical condition? While most cases of hives are not life-threatening, they can significantly impact quality of life due to persistent itching and discomfort. In rare cases, hives may be associated with a severe allergic reaction called anaphylaxis, which requires immediate medical attention.

Key Characteristics of Hives

• Appearance: Red or pink raised welts on the skin
• Size: Can range from small dots to large patches
• Duration: May last for a few hours to several weeks
• Location: Can occur anywhere on the body
• Mobility: Hives often move around, disappearing in one area and reappearing in another

Recognizing the Signs and Symptoms of Hives

Identifying hives is crucial for proper management and treatment. The primary symptoms of hives include:

1. Raised, red or pink bumps on the skin
2. Intense itching
3. Swelling of the affected area
4. Burning or stinging sensation
5. Blanching (whitening) of the center when pressed

How long do hives typically last? The duration of hives can vary greatly. Acute hives usually resolve within 24 to 48 hours, while chronic hives may persist for six weeks or more. In some cases, chronic hives can last for months or even years.

Associated Symptoms

In addition to skin manifestations, hives may be accompanied by other symptoms, especially in cases of allergic reactions:

• Swelling of the lips, eyelids, or throat (angioedema)
• Difficulty breathing or swallowing
• Abdominal pain or nausea
• Dizziness or lightheadedness
• Rapid heartbeat

Unraveling the Causes of Hives: From Allergies to Stress

Hives occur when the body releases histamine, a chemical involved in the immune response. This release can be triggered by various factors, both allergic and non-allergic in nature. Understanding these triggers is essential for effective management and prevention of hives.

Non-Allergic Causes of Hives

Non-allergic hives are more common and can be triggered by:

• Viral infections (e.g., common cold, strep throat, urinary tract infections)
• Emotional stress and anxiety
• Physical exertion and exercise
• Exposure to extreme temperatures
• Pressure on the skin
• Sunlight or artificial UV light exposure
• Vibrations from activities like lawn mowing or horseback riding

Allergic Triggers of Hives

Although less common, allergic reactions can also cause hives. These may include:

• Food allergies (e.g., eggs, peanuts, tree nuts, milk, shellfish)
• Medication allergies (e.g., aspirin, ibuprofen, naproxen)
• Environmental allergens (e.g., pollen, pet dander, latex)
• Insect stings or bites

Can certain medications cause hives as a side effect? Yes, some medications can trigger hives as an adverse reaction. Common culprits include nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and opioids. If you suspect a medication is causing your hives, consult your healthcare provider before discontinuing use.

Effective Treatment Strategies for Hives

The treatment of hives focuses on relieving symptoms and preventing future outbreaks. The approach may vary depending on the severity and duration of the condition.

Over-the-Counter Treatments

For mild cases of hives, over-the-counter antihistamines are often the first line of defense. These include:

• Loratadine (Claritin®)
• Fexofenadine (Allegra®)
• Cetirizine (Zyrtec®)
• Levocetirizine (Xyzal®)

How do antihistamines work to relieve hives? Antihistamines block the effects of histamine, the chemical responsible for the itching and swelling associated with hives. This helps to reduce symptoms and provide relief.

Prescription Treatments

For more severe or chronic cases of hives, a healthcare provider may prescribe:

• Higher doses of antihistamines
• Oral corticosteroids (e.g., prednisone)
• Omalizumab (Xolair®) injections for chronic hives
• Other immunosuppressive medications

Home Remedies and Lifestyle Changes

In addition to medication, several home remedies and lifestyle modifications can help manage hives:

• Applying cool compresses to affected areas
• Taking cool baths or showers
• Wearing loose, breathable clothing
• Avoiding known triggers
• Managing stress through relaxation techniques
• Using fragrance-free, hypoallergenic skincare products

When to Seek Medical Attention for Hives

While most cases of hives can be managed at home, certain situations warrant immediate medical attention. It’s crucial to recognize the signs of a severe allergic reaction or persistent hives that may require professional evaluation.

Emergency Situations

Seek emergency medical care if hives are accompanied by any of the following symptoms, which may indicate anaphylaxis:

• Difficulty breathing or shortness of breath
• Swelling of the tongue or throat
• Dizziness or fainting
• Severe abdominal pain or vomiting
• Rapid pulse or heart palpitations

How quickly can anaphylaxis develop after exposure to an allergen? Anaphylaxis can occur within minutes of exposure to an allergen, but in some cases, it may take up to several hours. Prompt recognition and treatment are critical for preventing life-threatening complications.

When to Consult a Healthcare Provider

Consider scheduling an appointment with a healthcare provider if:

• Hives persist for more than six weeks
• Over-the-counter treatments are ineffective
• Hives recur frequently without an apparent cause
• The condition significantly impacts your quality of life
• You suspect a specific trigger but are unsure

Long-Term Management and Prevention of Hives

For individuals prone to hives or those with chronic urticaria, developing a long-term management strategy is essential. This approach often involves a combination of medication, lifestyle modifications, and careful monitoring.

Identifying and Avoiding Triggers

Keeping a detailed diary of hive outbreaks can help identify potential triggers. Record information such as:

• Foods consumed
• Medications taken
• Environmental exposures
• Stress levels and emotional states
• Physical activities
• Weather conditions

Once triggers are identified, taking steps to avoid them can significantly reduce the frequency and severity of hive outbreaks.

Ongoing Medical Management

For chronic hives, ongoing medical management may include:

• Regular check-ups with an allergist or dermatologist
• Adjusting medication dosages as needed
• Exploring alternative treatments for refractory cases
• Allergy testing to identify potential triggers
• Developing an emergency action plan for severe reactions

What is the role of immunotherapy in managing chronic hives? While not commonly used for hives, immunotherapy may be considered in cases where specific allergens are identified as triggers. This treatment involves gradually exposing the body to increasing amounts of the allergen to build tolerance over time.

Differential Diagnosis: Distinguishing Hives from Other Skin Conditions

Hives can sometimes be confused with other skin conditions that present with similar symptoms. Accurate diagnosis is crucial for appropriate treatment and management.

Common Conditions Mistaken for Hives

• Eczema (atopic dermatitis)
• Rosacea
• Contact dermatitis
• Insect bites
• Heat rash
• Psoriasis

How can one differentiate between hives and other skin rashes? Unlike many other skin conditions, hives tend to be transient, often disappearing and reappearing in different areas within hours. They also typically blanch (turn white) when pressed, which is not characteristic of most other rashes.

Diagnostic Procedures

To confirm a diagnosis of hives and rule out other conditions, a healthcare provider may:

• Perform a thorough physical examination
• Take a detailed medical history
• Order blood tests to check for underlying conditions
• Conduct allergy tests (skin prick tests or blood tests)
• In rare cases, perform a skin biopsy

The Psychological Impact of Chronic Hives

Living with chronic hives can have significant psychological effects on individuals. The unpredictable nature of outbreaks, persistent itching, and visible skin changes can lead to stress, anxiety, and a reduced quality of life.

Common Psychological Challenges

• Anxiety about future outbreaks
• Embarrassment due to visible skin changes
• Sleep disturbances from itching
• Social isolation to avoid triggers or embarrassment
• Frustration with ongoing symptoms and treatment

How can individuals cope with the psychological impact of chronic hives? Developing coping strategies is crucial for maintaining mental well-being. This may include joining support groups, practicing stress-reduction techniques, and seeking professional counseling when needed.

Holistic Approach to Management

A comprehensive approach to managing chronic hives should address both physical and psychological aspects:

• Regular communication with healthcare providers
• Exploring stress management techniques (e.g., meditation, yoga)
• Engaging in regular physical activity
• Maintaining a balanced diet
• Building a strong support network
• Considering cognitive-behavioral therapy for anxiety management

By addressing both the physical and emotional aspects of chronic hives, individuals can improve their overall quality of life and better manage their condition.

Hives (Urticaria): Causes, Treatment and Prevention

Nationwide Children’s Hospital

Overview

Signs & Symptoms

Causes

Treatment

What to Expect

When to Seek Help

What Are Hives?

Hives are red, raised bumps on the skin that can be itchy. Hives are also called urticaria. About 1 in 5 people will get hives at some point in their lives.

What Are the Signs and Symptoms of Hives?

Hives can be found anywhere on the body. They can be small, like mosquito bites, or several inches wide. Even if they look different, hives often have common symptoms.

• People may have one hive or groups of hives that cover large areas of the body.
• Hives can move around on the body. They may start in one place, then move to another place on the body. 
• Hives may go away quickly or come and go for many weeks or months. 
• Skin swelling is common with hives. It may happen on the lips, ears, eyelids, fingers, or toes. This is common and not dangerous. 
• Less commonly, hives can occur as part of a more severe allergic reaction called anaphylaxis. Anaphylaxis can cause the airway to swell, making it hard to breathe. This is a life-threatening reaction that needs to be treated right away. 

What Causes Hives?

Hives happen when the body releases a chemical called histamine. It can be released because of allergies or other things, like stress, infections, or some illnesses. Whatever is causing histamine to be released is called a trigger.

• Hives not related to allergies are more common. Their triggers are:
  • Viruses or infections, like a cold, strep throat, or a urinary tract infection (UTI).
  • Emotional stress, like anxiety, anger, fear, or sadness.
  • Exercises that make the body warm.
  • Vibrations from using a lawn mower, horseback riding, or mountain biking.
  • Temperatures that are too hot or too cold.
  • Sunlight or tanning beds (sunlamps).
  • Pressure on the skin, like being rubbed too hard or scratched, or by wearing clothes that are too tight.

Hives that are related to allergies are less common. Their triggers are:

• Foods or medicines (anaphylaxis may occur) – Symptoms include nausea, throwing up (vomiting), mouth/throat swelling, and trouble breathing. This can be very dangerous.
  • Some common foods that cause allergies include eggs, peanuts, tree nuts, milk, and shellfish. 
  • Some medicines that cause allergies include aspirin, ibuprofen (Advil®, Motrin®), and naproxen sodium (Aleve®).
• Contact with the skin that can lead to irritation. These are usually not dangerous.
  • Plants, grasses, weeds
  • Acidic foods or sauces
  • Scents or fragrances (soaps, detergents, lotions)
  • Animal dander
  • Latex or other materials

When to Get Emergency Help

Call 911 or take your child to the closest emergency room if they have hives and any symptoms of anaphylaxis:

• Trouble breathing, swallowing, or talking
• Swelling of the mouth or tongue
• Nausea or vomiting

If they have an epinephrine auto-injector, like EpiPen®, Auvi-Q®, or Adrenaclick®, use it right away.

How Are Hives Treated?

Treatment depends on how bad the itching is. Even with treatment, hives can last days to weeks. The goals of treatment are to:

• Control the itching
• Avoid things that may trigger hives

For mild hives:

• Give an over-the-counter (OTC) antihistamine each day. Some examples are:
  • Loratadine (Claritin®)
  • Fexofenadine (Allegra®)
  • Cetirizine (Zyrtec®)
  • Levocetirizine (Xyzal®)
• Do not use Benadryl® creams. These may cause irritating rashes.
• Cool the skin using an ice pack or a cold bath or shower.
• Distract your child by playing games, singing songs, or reading books.
• Avoid known triggers, like animal dander or fragrance.

For severe hives:

• Give a higher dose of antihistamines or steroids, like prednisone. Oral steroids should not be used a lot. They may make hives worse when you stop taking the medicine.
• See a doctor or health care provider. They may prescribe a medicine, like Xolair® shots (injections), if you have long-term (chronic) hives.

Living With Hives

Living with hives isn’t easy, especially if you don’t know what’s causing them. It may help if you write down events that happened right before the hives appeared. This can help you and your child make a plan to keep the hives from coming back.

Depending on what’s causing your child’s hives, you can keep their hives from getting worse by having them:

• Avoid scratching or rubbing their skin.
• Wash their hands after touching pets or animals.
• Wear loose-fitting clothes. • Wear warm clothes. 
• Wear sunblock and long sleeves and pants in the sun.
• Avoid contact with cold water if they’re sensitive to cold.
• Use mild, unscented soap on their skin and for washing clothes.

When to Call the Doctor

Call the doctor or health care provider if your child’s hives get worse or prescribed medicine isn’t helping.

Hives (Urticaria) (PDF), Spanish (PDF), Somali (PDF)

HH-I-82 11/89, Revised 2023, Nationwide Children’s Hospital

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Itchy bumps on skin like mosquito bites: What are they?

Several skin conditions can cause itchy lumps that resemble bug bites. These include allergic reactions, infections, and chronic conditions.

Most people experience this symptom at some point. Itchy bumps can appear as a result of allergies, infections, insects, and, sometimes, nonidentified factors.

However, there is one general principle that the American College of Allergy, Asthma & Immunology recommend people to follow when their skin itches: Do not scratch it.

Additional general self-care practices for itchy skin include:

• bathing frequently in lukewarm water
• using gentle, hypoallergenic soap
• limiting exposure to the sun
• applying cold compresses
• avoiding tight clothing in areas where itchy bumps appear

Understanding the different conditions that can cause itchy bumps on the skin can help people get appropriate treatment. Depending on the cause, treatment can range from avoiding certain foods to taking prescription medications.

Keep reading to learn more about some common causes of itchy bumps that look like mosquito bites and how to treat them.

The medical term for hives is urticaria, and it describes a condition that produces raised itchy areas on the skin. If a person notices bumps on the skin that resemble mosquito bites but has not had any exposure to mosquitos, the cause is probably acute urticaria. The term “acute” means that the condition does not last longer than 6 weeks.

Hives are very common, affecting about 20% of people at some point in their lives. Certain kinds of foods, such as peanuts, tree nuts, and seafood, cause hives in many people due to an allergic reaction. Latex, pollen, insects, various plants, and some medications, such as sulfa drugs or even aspirin, may also cause hives.

Hives cause characteristic red, purple, or skin colored itchy bumps that appear and disappear quickly anywhere on the body. These bumps typically turn white or disappear when a person presses them.

Treatment

The treatment for hives depends on the severity and cause of the rash, but it includes avoiding known triggers. People who are extremely allergic to a trigger — for example, peanuts or certain insects — may need to carry an epinephrine auto-injector, such as an Epipen. This device can stop a potentially life threatening reaction if a person has accidental contact with a known allergen.

Anti-itching lotions and over-the-counter (OTC) antihistamines can provide relief for mild symptoms, while more intense outbreaks may require stronger prescription versions of these drugs or corticosteroids.

Learn more about hives here.

According to the Centers for Disease Control and Prevention (CDC), bed bug bites can resemble bites from other bugs, although they can take as long as 2 weeks to materialize.

People who notice itchy bumps on the skin that resemble mosquito bites should check for:

• other signs of bed bugs
• bed bugs themselves on a mattress or sheet
• dead bed bugs
• blood spots on a mattress or sheet
• the characteristic musty smell associated with bed bugs

If the bites appear in a straight line, they are likely to be due to bed bugs. However, bed bug bugs can also appear in more random formations.

Treatment

Unless someone has a severe allergic reaction, experts recommend simple self-care practices to treat any bites. These include not scratching, applying OTC antiseptic ointments, and taking antihistamines.

Learn more about bed bugs here.

Contact dermatitis is essentially an allergic reaction that develops when a person’s skin comes into contact with something to which they are allergic, such as latex or certain metals or household products.

It can take 1–2 days for the reaction to develop and 2–3 weeks for symptoms to disappear. Contact dermatitis may hurt as much as it itches, and it may present with inflammation and blisters.

Treatment

Self-care with cold compresses, calamine lotion, and soothing baths can help provide relief.

Prescription medication, such as antihistamines and cortisone, may be necessary if the reaction is severe.

Working with healthcare professionals can help people identify their triggers, which can be complicated.

According to the American Academy of Allergy, Asthma & Immunology, there are more than 3,700 substances known to cause contact allergies. Avoiding triggers is a key part of managing contact dermatitis, along with thoroughly washing the affected area with soap and water after exposure happens.

Learn more about contact dermatitis here.

The human itch mite is responsible for scabies. This mite digs its way through the top layer of the skin and lays eggs. Its tunnels can sometimes be visible on the surface of the skin, where they appear as raised, crooked, skin colored lines. However, the most common symptom of scabies is itchy bumps on the skin. These are like mosquito bites, only smaller.

Sites of the body that this very itchy condition commonly affects include the wrists, the elbows, between the fingers, and behind the knees.

Treatment

Only a prescription lotion will treat scabies effectively, and individuals need to follow the application directions exactly. Anyone who has had extensive skin-to-skin contact with someone with scabies should also seek treatment.

It is very important that people with scabies thoroughly wash and dry all of their clothes, towels, sheets, bedding, and other household items. Other remedies for scabies may also help.

Learn more about scabies here.

Also known as atopic dermatitis, this common condition causes itchy, red, irritated skin that can sometimes develop bumps. In the long term, it can make the skin thicker, scaly, and flaky, as well as causing it to change color.

Scratching makes eczema worse and increases the risk of infection. Eczema occurs due to a combination of genetic and environmental factors, which prompt the immune system to overreact to certain triggers, such as laundry soap or sweating. It typically affects the face, elbows, knees, scalp, and backs of the hands.

Treatment

According to the National Eczema Association, treating eczema calls for a mix of self-care, OTC drugs, and prescription medications. People with eczema can identify and learn to manage or avoid triggers for their outbreaks.

Changing bathing practices and using moisturizer can also help. Prescription lotions, systemic medications, UVB light, and biologics can address more severe symptoms.

Learn more about the different types of eczema here.

Skin problems, such as itchy bumps on the skin similar to mosquito bites, can range from mild to severe.

Some issues, including bed bug bites, can be fleeting, while others, such as allergic reactions to certain foods, are signs of a permanent condition. However, most skin problems generally respond well to treatment.

If the symptoms do not improve with self-care practices, people should see a medical professional to determine what is causing the outbreak and how to treat it.

Mosquito bite rash

Skin infections, especially those with a diagnostic sign of rashes, are one of the most common reasons young children go to the doctor. Adults also suffer from this skin problem; however, most of them choose self-diagnosis and self-treatment. Identifying a rash is never an easy task, and it’s even more difficult because one type of mosquito bite-like rash can have different causes and relatively common symptoms.

Pay attention to aspects of the rash

Allergic reactions to food, viruses, metals, bacteria and other skin irritants can cause mosquito bite rashes. In most cases, the rash does not indicate a dangerous condition, but in some rare cases it does. When you find a rash, spend as much time as possible paying attention to how the rash looks. Pay attention to how long it has been present, how widespread it is, whether it itches or not, how big and how many spots you have.

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• Insect bite rash
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The role of histamine

The lining of the skin contains many mast cells that are designed to attack and destroy parasites. These cells carry sacs filled with chemicals, including a protein called histamine. When an allergic reaction occurs in the body caused by an allergen, the body releases histamine. Once in the bloodstream, the fluid leaks out of the blood vessels, accumulates in the skin, and causes a rash. Thus, itching, swelling and irritation.

Urticaria

Urticaria is a skin disease similar to mosquito bites.

What they look like: Medically, urticaria is smooth, raised, with pink to reddish bumps or wheals that can vary in size. They may also be ring, oval or circle shaped with a pale center and a red halo or flare on the outer edge. The redness of the spots may disappear and turn pale with pressure. Wheat also disappears within minutes or hours and is replaced by newly formed ones. As a rule, bulging bumps appear in groups, covering the whole body or part of it, accompanied by very intense itching.

What causes them: According to the American Academy of Allergy, Asthma and Immunology, hives are often associated with medications and food allergies. Very common triggers are allergic reactions to pollen, pet dander, or seafood. There are many causes of irritating skin allergies, and some of them have unexpected triggers.

• Training or exercise: Many people think that a rise in body temperature causes hives. But what actually causes hives is your own sweat.

• Cold temperatures: Cold climates can exacerbate the disease in some people. This includes other causes associated with a cold, such as swimming pools or eating chilled food.

• Infection Response: Researchers have found that several bacterial and viral infections, including tooth decay, have a role in the development of hives.

• Stress: High levels of cortisol (the stress hormone) are associated with chronic urticaria and may exacerbate them.

• Sunlight and heat. Although hives are rare, some people get hives after sudden sun exposure. This happens if you were indoors in winter. Your body may suddenly explode and a red, itchy rash will appear on his body. It can also appear in areas that have been covered for several months and then exposed to sunlight abruptly.

Home remedies: The first step is to discover your potential triggers. They must be avoided to prevent hives. Healthy eating habits can reduce the chance of hives. Cool oatmeal baths can also relieve an itchy rash. After bathing, apply topical medications, such as calamine lotion or 1% hydrocortisone cream, to the affected area to relieve itching.

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Applying an ice pack to the rash also provides relief. Also, cut your nails short to avoid scratching the rashes. Wear loose clothing to prevent further irritation of the affected skin. Over-the-counter medications such as oral antihistamines are also the preferred choice for blocking the release of histamine (a compound that causes allergic symptoms).

When to see a doctor: If your hives do not go away after home treatment and you have other serious symptoms, such as swelling of the lips and difficulty breathing, go to the emergency room right away. Also, for rashes that are accidentally scratched and have caused an infection due to an open wound, see a doctor.

Heat rash (heat rash)

Heat rash is a condition that causes a rash with bumps on the skin.

What it looks like: Heat rash, also known as prickly heat or sweat rash, is a common condition in humid or hot weather. Heat rash is very similar to hives. It shows red, itchy, raised bumps on the skin. Unlike urticaria, which affects any age group and is widespread, heat rash is smaller and more common in children. It usually appears in places where sweat accumulates, such as the neck, upper chest, or elbow creases.

What causes it: As a rule, skin rash is mainly caused by blockage of the sweat ducts in summer or hot weather. For example, a child who is overdressed under the scorching sun may develop a heat rash. Heavy use of creams also contributes to clogged pores during exercise.

Home remedies: Heat rashes usually resolve within a couple of days after air drying. Loosening and removing clothing will also help. Allow the skin to cool while monitoring the temperature. Stay in air-conditioned rooms or use cold compresses. Other treatment options for heat rash include applying calamine or hydrocortisone creams to soothe the rash. It is also important to avoid other lotions as they can aggravate the irritation of your sensitive skin.

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When to see a doctor: An increase in heat rash within three to four days is reason enough to seek advice. Immediate medical attention is needed for severe itching and rashes with pus and swelling.

Irritant contact dermatitis

Irritant contact dermatitis may cause a mosquito bite-like rash.

What it looks like: In addition to allergic reaction rashes, a more common type of contact dermatitis is irritant contact dermatitis. At first glance, it can be confused with beehives as it shares most of its characteristics. It starts with a red rash and bumps followed by itchy dry skin. During a hypersensitivity reaction, raised papules form on the skin in the affected areas. A flaky rash may also appear. However, its distribution differs from hives. This type of contact dermatitis affects areas that are only exposed to irritants.

What causes it: The main cause is repeated contact with an irritant that rubs against the skin and damages the surface of the skin. It is caused by a reaction to certain substances, such as detergents, perfumes, cosmetics, soaps, metal jewelry, deodorant, or other personal care products.

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Home remedies: Avoid anything that causes symptoms. Avoid strong substances that can irritate the skin. The constant friction of clothing fabric makes your skin more susceptible to injury, so choose cotton material over bulky fabrics because they are less irritating. Treat the area with hydrocortisone or anti-itch cream and then take a dose of antihistamines. A moist compress can be applied to relieve mild to moderate symptoms.

When to see a doctor: Severe symptoms, such as painful and widespread rashes, require a doctor’s consultation. See an allergist and get a patch test if you can’t pinpoint the cause of the rash. Also, if the rash begins to interfere with your daily activities and causes lack of sleep, seek medical attention.

Looking for the culprit

You don’t have to go to medical school to determine the root cause of a rash. With a bit of acquired knowledge and a few tips on how to check their characteristics, you can prevent them and treat them yourself.

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