Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
Hives Uncovered: What You Need to Know
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Chronic hives can hijack your sleep, focus, mood, and confidence, and the hardest part is often not knowing why it’s happening. Board-certified dermatologist and Northwestern associate professor Dr. Walter Liszewski joins us to break down the biggest myths around urticaria, explain the difference between acute and chronic hives, and walk through common patterns like dermatographism, pressure hives, heat-triggered flares, and exercise-induced hives.
We also get practical about treatment: when allergy testing actually helps, why Benadryl and steroids are not great long-term solutions, and how newer therapies like omalizumab, dupilumab, and remibrutinib are changing care for people stuck in the chronic hives cycle.
A Quick Teaser On Hives
SPEAKER_00Our body has a response and it swells. The deeper part of the skin we call the dermis will start to swell. And sometimes, if we can adjust the thyroid, the hives may normalize, the hives may go away. Dealing with this horrible rash, impacting their quality of life, impacting their mental health, just so they can get tests that are going to cost thousands of dollars that are not going to change their management. Even when we've looked at your skin, even if we've done blood work, we don't really know how long it's going to last for.
SPEAKER_01Welcome to Dermit Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.
Meet Your Dermatology Hive Expert
SPEAKER_02Welcome to the Dermitrotter, Don't Swear About Skin Care Podcast. I've got Dr. Walter Lachevsky on today. He's a board-certified dermatologist, associate professor at Northwestern, expert and contact dermatitis, and he loves anything that causes itchy skin. So he's perfect to have on the podcast today to talk about hives. Welcome to the podcast, Walter. It's great to have you here.
SPEAKER_00Thank you so much. I think you just encapsulated my entire academic career. You're spot on. You're spot on.
SPEAKER_02We love to be concise here and accurate. So that's what we're all about on this podcast. And I think there's a lot of inaccuracies or misconceptions about hives, what we refer to, you know, in the medical world as urticaria. And people just having an understanding of really what it is, why it happens, and sort of the different types as well. So I was going to have you talk a little bit about that to sort of set the stage for us.
Acute Versus Chronic Hives
SPEAKER_00Yeah. So hives are these itchy red bumps, and we've all experienced them. Think of a mosquito bite. That is a good example of a hive where our body has a response and it swells. The deeper part of the skin we call the dermis will start to swell. Now, there's two different buckets, two different reasons why people get hives. The first are what we call acute articaria or acute hives. And when that happens, it can happen due to things like bug or insect bites. After you have a cold, you may get a rash. It can also happen sometimes if you're allergic to cats or dogs and you're around them. Your skin becomes itchy, but within a couple hours, it goes away. It's not an ongoing problem. The other type of hives, which we call a chronic urticaria or chronic hives, is when someone has hives daily or almost daily for more than six weeks. Now that's that's different. Whereas acute urticaria usually has an identifiable cause like a mosquito bite or the flu. Chronic urticaria is different where it's our immune system being wonky and it's causing our skin to make welt all over the body.
SPEAKER_02I think that's frustrating for patients, especially if they've had it more than six weeks. And all of my listeners out there are like, I just want to know why, right? Like, I want to know why I've got it. And I think the disappointing reality is, you know, we may never truly understand or identify a cause. And it's a hard thing to accept. But I tell them we kind of know the why in the immune system and why it's happening, which obviously helps us for treating it. What about these other forms of hives? Like, you know, I just wanted to comment briefly because I know we could have a whole conversation about it. But for example, myself, I'm somebody if I scratch myself, I get a little dramatographic, you know, I have some high histamine levels in my skin, or, you know, pressure for myself too. If I wanted to fit into those genes that were a little too tight around the waistband, I might wind up uh with a hive there and be scratching along those areas. So, what other forms of hives are there that are
Physical Triggers Like Heat And Pressure
SPEAKER_02out there?
SPEAKER_00Yeah, so the other form of hives is something called a chronic inducible urticaria, or what we used to call a physical urticaria. And it's when an outside source is applied to the skin, and then you develop hives. So different causes include dermatographism. That's when if you were to scratch your arm with your nails, there'll be a linear streak of hive where that pressure was. Some people get it from sitting, some people can get it from very cold weather, and some people can get it from working out. We oftentimes see this, I'm sure you see this in clinic too. A patient comes in, they say, I'm itchy when I go to the gym. As soon as I get on the treadmill, I start to itch. That's the type of physical urticaria, what we call a cholinergic urticaria, where the body secretes chemicals to activate the sweat glands in order to cool our body down. But when they do that, in some people, it causes their cells to also become activated, resulting in hives and itch.
SPEAKER_02Yeah, I'm just using it as an excuse not to work out when that happens. That's all I'm doing with that. Plus, I don't get the dopamine high that runners get. I get that more from eating a piece of chocolate than I do. Yeah.
SPEAKER_00Everyone's different. Yeah.
SPEAKER_02Exactly. But I think it's fascinating, like you talk about these other reasons people get hives. Because I think, you know, patients are shocked to hear, like, wow, just something as simple as me working out or pressure, just things like that. And I think what I see a lot too is often, you know, with heat, people will come out of the shower, you know, and they're all streaking red and scratching themselves where they get that dump of histamine into the skin. You know, we we talked a little bit about the cause factor. You know, I think people want to know then, okay, if will you look for a cause, even though we maybe don't, you know, find it
Labs And Why Allergy Tests
SPEAKER_02most of the time. Is there, you know, lab work that I need to have done, or what do you like to do for somebody who comes in that has hives, especially if it's greater than six weeks, what's sort of the process to work that up?
SPEAKER_00Yeah. So in if you haven't had hives for at least six weeks, the standard of care, meaning what do a dermatologist or an allergist collectively agree is a specialty, is necessary or not. The opinion is we don't do labs. Once it's been there for about six weeks, that's when we consider doing diagnostic tests. Now, one of the things that's frustrating with people with chronic hives is that we know most patients tend to be between the ages of 20 and 40. We have a lot of people who've never had medical problems. And so all of a sudden, they have this new medical problem they've never had before. It's itchy, they can't sleep, they can't focus, they can't do their job, and it's quite debilitating. And because of that, people want to know why this is happening. Now, the key thing here is that although some forms of hives, those acute hives, can be associated with allergies like grass or pollen or cats or dogs, the chronic hives are not associated with allergies. And therefore, routine allergy testing is not indicated for chronic urticaria. Sometimes we will do blood work and we'll look at things like liver function, kidney function, and we'll test uh thyroid function, and we're looking for diseases that may coexist with hives or blood work that may suggest an underlying cause of the hive. However, in the vast majority of cases, nothing remarkable is found with this blood work. Because of that, it can be very frustrating to see a dermatologist for hives, and you come into the visit, you've been waiting for weeks, you're just itchy, and then they say, Yeah, we're not going to do allergy testing. But the reason why is that it's not the standard of care. We know that when we do allergy testing, we almost never find something. It delays our treatment and it adds to health care expenses, and it doesn't change outcomes.
SPEAKER_02I just want you to preach on about that because I think that's one of the greatest misunderstandings, you know, for our patients, which I understand. I think there's this automatic assumption. And I think some of our colleagues too, you know, where I know, you know, even a couple of my friends that are in the primary care space, like, oh, I was used to sending to allergy. That's kind of how we were trained. I tell them, no, send them to dermatology. We we really do manage this primarily. And even though we might do the workup you mentioned, the allergy testing in that chronic situation is of little utility for us to really look at. And like you said, it adds a lot of cost to the healthcare system. But one thing I want to pick your brain about that you mention are some of these underlying causes that we could identify or what work might reveal. Because I think a lot of people are thinking, okay, well, if you're gonna go that route to maybe find an actual reason why I'm breaking out on hives, what typical things would you see that might explain hives in a patient that you would find doing that workup?
SPEAKER_00Yeah,
Thyroid And Infection Links
SPEAKER_00so there's a couple things. The first would be abnormal thyroid disease. So the thyroid kind of rests over our throat and it secretes a variety of hormones that regulate a variety of uh processes within our body. It's a really important tissue. Now, for some people with chronic articaria, their thyroid function may be too high or it may be too low. And sometimes, if we can adjust the thyroid, the hives may normalize, the hives may go away. That can happen. There are some cases where hives may be associated with infections, such as the hepatitis virus infection, either hepatitis B or hepatitis C. And then I also test for something called H. pylori. It's a bacteria. It's not very common in the U.S., it's more common in developing countries, but it's a bacteria that will just sort of live long-term in our stomach or in our GI tract. And in some people, it becomes active, causes inflammation, and that can cause hives. Is that what causes most cases? No, these are fairly uncommon causes, but it's not uncommon for me and for my colleagues to look for these potential causes.
SPEAKER_02So if you find one of those things for abnormal, they have an infection like H. pylori or hepatitis, if you treat the underlying infection, do the hives pretty much go away on their own, or are you still having to approach that with treatment to go after the hives directly?
SPEAKER_00That's a great question. Usually once you treat the disease, the hives improve.
SPEAKER_02So hope if you find that cause. And just to give an estimate, you know, with the number of hive patients you treat, how many times do you actually find something on that lab work? How common is that?
SPEAKER_00Hepatitis is zero. Um I've yet to find someone with active hepatitis with CSU. With H. pylori, I'd say it's about five to ten percent, but that risk is not even. That risk is in very specific patient populations. So patients who are immigrants to the U.S. coming from developing countries, people who have lived for long periods of their life in developing countries, that's where you tend to see H. pylori infections. It's people who've never left the United States, yeah, they could have H. pylori, but the risk of that is lower. And one of the key things to really emphasize for listeners is that although there are a certain number of infections that could be associated with CSU, we do know the vast majority of cases really do not have an identifiable cause. And we can do a million dollars worth of blood work, and we're probably not going to find a root cause. We're not going to find a reason why all of a sudden it developed.
SPEAKER_02Do you find thyroid diseases very common, or do you feel like, again, small percentage of the patients you identify?
SPEAKER_00Very small percentage. Now, in the uh in the dark ages, back before we had great drugs for CSU, one of the things that I'll just say, one of the things that I love about being a dermatologist is that I feel like I'm a wizard. I make all kinds of potions and combinations and I do things very differently. And dermatology is very different than many fields of medicine. Like in cardiology, you basically follow a flow chart and everyone does the same thing. In dermatology, everyone has a different experience. Everyone manages the disease very differently. And CSU, up until about 10, 15 years ago, we really did not have great drugs. And it was a very difficult disease to manage. And one of the ways that people used to manage chronic urticaria was to give people thyroid replacement, even if their thyroid function was normal. And in some patients, it actually works. I am not encouraging anyone to do that. Please do not do that. But the point of it is that historically there was an association between looking for thyroid disorders and fixing or perhaps supplementing thyroid function. And sometimes it can help with chronic articaria.
SPEAKER_02That's fascinating to interesting to look at too, you know, historically. But you're right, I think we all always want to blame things on the thyroid. It is a pesky gland. It's useful when it's working right, but you know, when it's not, it definitely can cause some problems in the body.
SPEAKER_00Every part of the thing is, no, I was gonna say a lot of things can fall apart, but sometimes too, our thyroid is more resilient than we think. Even if your thyroid function levels are normal, it doesn't mean it's the cause of a disease or a problem. I know we see this all the time with hair loss. I mean, you your thyroid really has to be out of whack in order for it to cause substantial hair issues. Because a lot of people have mild dysfunction to their thyroid, but they're able to walk around really with no issues.
SPEAKER_02Yeah, I think it's a gland that becomes the scapegoat for a lot of problems too. You're right. We don't have to what people think
When A Biopsy Is Needed
SPEAKER_02of. So, besides like this workup, obviously doing lab work, what about a skin biopsy? Because you know, I think patients want to do I need to have a biopsy to really diagnose hives, or do you consider doing one maybe in particular circumstances as well?
SPEAKER_00Yeah, so it in medicine, we have a concept called the clinical diagnosis. And what a clinical diagnosis means, our patient comes in and we want to ask you questions. It's going to ask you all kinds of questions to figure out how long, what does it feel like, and then we'll do an exam. We're gonna look at the skin. We may touch the skin, we may palpate it, and based on what you told us, based on what we see, we can reach a diagnosis. So that is what we call a clinical diagnosis. So for hives, we don't need to do biopsies because we can make that diagnosis with the words you tell us based on your history and what we see. Now, there is something called an articaryovasculitis, which is a variant of hives, and that's when someone has a lot of inflammation, not only in the skin, but also in the blood vessels. It's uncommon, and someone with articariovasculitis will not only have hives within the skin, they'll have fevers, chills, severe muscle aches, severe joint aches to the point they can't walk. In that situation, we oftentimes will do a biopsy, not because we're looking for hives, but because we're looking for evidence of inflammation of those blood vessels.
SPEAKER_02Yeah, and I think that's kind of fascinating. People don't, it's a less known entity, but something that could walk through the door too and be a hive mimicker. Because I think that's where a lot of patients always wonder how can you make that diagnosis? And understand just clinically, we can often look at photos in history or even in person to help make that diagnosis and come to the conclusion. Yes, you definitely look like you're a hive patient. But I we I want to go back to the allergy concept a little bit because we talked about the fact that typically we're not gonna make that referral. Are there instances though where you feel like it's valuable? You mentioned maybe more on the acute hive side, you know, that maybe it's valuable there. But I know there's a lot of pressure from patients that allergy is kind of the big place they want to go. Or are there exceptions or where you find it's even valuable to entertain that referral?
SPEAKER_00Yeah. So if someone says, I've been dealing with hives every day and they go away, but then when I go over to my parents' house and I'm around their dog, it sets off an episode where it lasts for weeks. All right. That's like the one situation. And the key thing to understand about allergy testing, allergists do not like shotgunning allergies. They're not going to order 100 different allergens. You've got to come in with a story. When I'm exposed to Y, then Z happens. You need to have a good idea about what your potential triggers are. The other thing is that I remind patients that we have something called guidelines. And what guidelines are are when a bunch of really smart doctors sit down and they say, okay, how can we best manage a disease based on what we know from the literature, based on previous trials and our scientific knowledge? And there's an organization, it's a long one. Okay, you ready? It's called the Quad AI. It's the American Academy of Asthma, Allergy, and Immunology, and it's the National Organization for Allergists. And a couple of years ago, they put out guidelines on managing chronic hives, and they'll be updating them soon. But one of their key takeaways is they don't mince words here. They are very clear. There is not evidence for routine allergy testing for chronic articaria. It results in unnecessary testing, excess cost to the patient and to the healthcare system, and it delays treatment. What I mean by it delays treatment, I don't know what it is in your neck of the woods, but for me in Chicago, it can take many months for a patient to get in to see an allergist. And so if a patient comes in, they have hives, they're itchy, they're uncomfortable, they can't sleep, and they want allergy testing, they're gonna have to wait months dealing with this horrible rash, impacting their quality of life, impacting their mental health, just so they can get tests that are gonna cost thousands of dollars that are not going to change their management. And it's very, very challenging because, again, the patient population that gets chronic hives tends to be a group that really hasn't had medical problems before. And to go from normal two months ago to now being constantly itchy, it's challenging. Any of us would struggle with that. Um, but it's important to realize that the best and brightest people in this field, they made the decision. There is not evidence for routine testing. And that's that's what I tell patients.
Antihistamines And Dementia Concerns
SPEAKER_02So even though not good evidence for routine testing, what about we start getting to treatment? Because I think that's where a lot of people are concerned, and maybe some things they wrote on the news about, you know, using antihistamines, right? So there's been a lot of publicity dedicated to this, maybe increasing, you know, risk of dementia, especially in older patients. And I I have people coming in now that are afraid when I talk with them about first line treatment. We like to use antihistamines. So I wanted you to comment a little bit on your perspective on appropriateness, safety, and especially when we're using pretty high doses, too.
SPEAKER_00Yeah. So when it comes to antihistamines, we have the first generation and the second generation. The first generation, all of you are probably familiar with Benadryl or diphenhydramine. So the first generation antihistamines are very good at controlling hives, but they also make you very tired because they can get into what we call the blood-brain barrier. Our brain is covered in this membrane, and most drugs, bacteria can't get in. But drugs like Benadryl are sneaky, they can get in, and that's why most people get sleepy when they take Benadryl. We don't like giving people Benadryl, particularly for long periods of time, due to the risk of them falling or hurting themselves from being drowsy. And as you mentioned, there is some evidence, there's a little evidence that long-term use of first-generation antihistamines may increase the risk of diseases like dementia or Alzheimer's later in life. However, we have our second generation. These are very effective and they have fewer side effects. Um, these include things like citirazine, flexifenidine, loratidine, and levoctirazine. And these have a variety of names. These are their brand names for things like Allegra or Xyrtech or Claritin or Xyzol, and you've probably seen these at the pharmacy before. These do not cross the blood-brain barrier, and these can be used to control hives. The nice thing about these pills are they're inexpensive and they work well. Now, if you read the package, it may say to only take one per day, but the guidelines from, again, the Quad AI are that it's safe to take up to four. Why four? The reason is once you take more than four, you reach a saturation point where adding in additional antihistamines doesn't work. Now, one thing I tell my patients is, you know, we could have a Zyrtech eating contest. Nothing's gonna happen. Uh, because patients are, you know, taking four pills a day is a lot, again, particularly for people who are not used to taking medications. It can be very concerning, but it's important to reassure them that at those doses, they have been shown to be safe even for long-term use, and they can be highly effective, and they're also very cost effective.
SPEAKER_02What are
Why Steroids Are A Trap
SPEAKER_02your thoughts on, you know, taking things like you know, Fomotadine or you know, other type histamine? Why? Because you know, I've had patients come in and like, hey, I'm I'm on this in addition to you know taking vexaphenidine, is this helpful for my hives? Like, do you feel like that's an appropriate add-in or a little are we overdoing it?
SPEAKER_00Yeah. So there's a variety of other anti other histamines released in the body. Um so we have our antiacids, so things like phomodidine, which are H2 blockers. And historically, when we didn't have a lot of great drugs for chronic urticaria, we used to use drugs like Fomodidine or rhinitidine or something called a leukotriinine inhibitor. Um, because the antihistamines alone didn't control everyone. However, we're in an age now where if the antihistamines don't work, we have very clear guidelines that after a few weeks, rather than adding in things like phomodidine or rhinitidine, we should move on to what we call an advanced therapy.
SPEAKER_02And what about those? I I got to touch on the steroids. I've got my steroid lovers out there. Because they're used to getting those maybe elsewhere and coming in, they're they're astonished, you know, that that's not going to be one of my first line go-to's. How do you walk people or counsel them through that? Because I still think, you know, depending upon maybe where they've been, it could have been urgent care, maybe their primary care doctor, their emergency department. They may have received prednisone in the past or another form, dexamethasone, loved it, wanted more. And so I want you to kind of, you know, get dispel that myth too about that being the best treatment choice because it gets addictive, the the immediate relief and benefit, but obviously not a good long-term treatment strategy.
SPEAKER_00I hate when patients with chronic hives come in who've been on prednisone and want more because I'm the bad cop. I'm the buzzkill. Okay. Prednisone is amazing. It works well. And especially if you've been dealing with hives, you can't sleep, you can't focus, and all of a sudden you get a couple days of relief. It's life changing. And you want that. The problem is long term use of steroids can demoneralize. The bones, it can increase your risk of infection, it can alter your blood sugar. It's also just not sustainable. And so while predazone can be helpful in very rare circumstances, what we need to do is if someone is dependent on steroids, is to pivot and to move to something that is safe to use long term, but does not have all the side effects that oral steroids do.
SPEAKER_02Well, that's a great segue into where we're at for hives now, because you already alluded to this earlier that we have great options that are steroid sparing or steroid-free that can really give people long-term relief.
Advanced Meds And Remission Strategy
SPEAKER_02So I wanted to talk about kind of the big three that we have available to us now.
SPEAKER_00Yeah. So I meant a little bit earlier, I mentioned um guidelines and algorithms and the International Group for Chronic Earticary or Chronic Hives, it's a group of multiple organizations. They basically rewrote their guidelines and it's four steps. It's really straightforward. If you've had hives for at least six weeks, you should start taking second generation antihistamines. You can take up to four of them daily. If after two to four weeks you're not better, then you move to the next step, which is one of these advanced therapies. The first one is a shot called omolismab. The second one is a pill called dupilumab. And the third one is an oral pill called Remibrutnib. Each of these work in different ways, but overall they're very, very effective treatments with overall fairly bland mild side effect profiles.
SPEAKER_02And I'm gonna have you repeat that. Um I don't know if you caught it. You said um dupilumab was an oral pill. I'm gonna have you just repeat that. No, you're fine. Um we'll just that out and I'll have you repeat those treatments.
SPEAKER_00All right. So there are three treatments that are currently available. The first one is omalisimab, it's a shot that's given every four weeks. The second one is dupilimab, this is a shot given every two weeks. And the third is a pill called Remy Brutnib, and it's taken twice a day.
SPEAKER_02So I take it with nearly as many high patients have you seen. How do you kind of pick or choose, you know, between those options? Are there certain scenarios that you feel like one's maybe better for maybe a certain patient sort of profile or look, or if they have other conditions going on, maybe, or do you usually try one if maybe another one hasn't worked so well? How do you kind of work through that? Because I'm sure there's some hive patients out there like, oh, I'm on one of those right now, but I'm not seeing the improvement I want. You know, how do I one gauge if I'm not getting control and then how do you go to the next?
SPEAKER_00So a couple things there. Um, chronic hives come in two flavors. I won't get into the weeds about this, but broadly, we know based on the blood cells that are involved, there's something called a type 1 and one called a type 2B. All right. The oldest of these three drugs, uh omolysimab, really works well for the type 1, which is what the vast majority of patients with chronic hives have. It didn't really work so well for patients with the type 2B. The two newer drugs, dupilumab and remibrutnib, do work for both the type 1 and the type 2b. So if a patient has blood work that suggests they have more of a type 2B profile, I will probably recommend Remybrutnib or dupiliumab. If someone has multiple other what we call atopic diseases, so these are things like asthma or eosinophilic esophagitis or really bad um seasonal sinus problems, then I may recommend dupilumab. If someone says, I don't want to take a shot, then Remy brut nib is a great option. I also really like Remy brutnib because it works very, very quick. And so if someone is absolutely miserable, I know I can put them on Remy brutnib, and within a matter of days, they're gonna feel amazing.
SPEAKER_02So I take it you've seen then with this new, you know, I feel like I've seen it myself, you know, just availability drugs, just tremendous control for patients with hives. But the one question I think every patient has is can I get off these medications? And if when can that happen? Because you know, we're all talking about remission now in dermatology, that concept in psoriasis, eczema. And I think for the hive patient, they're hoping for this concept as well. So in our last few minutes here, I to give maybe some hope here where we're headed in the future, wanted you to comment on this concept of remission, or is there a possibility to get off any of these medications in the future?
SPEAKER_00Yeah, remission is definitely possible with chronic hives. We do know that on average, most patients unfortunately will have chronic hives for five years. However, unlike other dermatologic diseases like psoriasis, which never really go away or only go into temporary remissions, it is possible for chronic urticaria to just disappear and never come back. Part of what's challenging though is when you're in front of us, even when we've looked at your skin, even if we've done blood work, we don't really know how long it's gonna last for. And so my approach is to get people under control, get the hives, get the itch, get their quality of life under control. And then once they're stable, after, say, six months or a year, that's when we can start adjusting the frequency of dosing. So if someone is on omalismab and they're taking shots every four weeks, if they've been stable for a year, I may move them to every five weeks. So we have the ability to slowly push things out and see are things really gone or are they still rip-roaring and the medication is just covering that up.
SPEAKER_02I think that gives hopes to hope to people, you know, that you know, we can actually get there one day with hives. And it just speaks to, like you mentioned before, Walter, your wizardry. You know, you wanted to be the wizard, so the derm was yeah, can come in. If you can get people off their hive medications, they will definitely believe you've worked some magic on them
Hopeful Wrap And How To Help
SPEAKER_02as well. Well, I want to thank you so much for coming on the podcast. Oh, sorry, because you have something else you want to say.
SPEAKER_00I just wanted to say one thing, and that is we are so fortunate for 2026. We have such great medications for chronic herticaria. Unfortunately, in dermatology, we have a lot of diseases that are really tricky. For example, hydroetiditis. Chronic herticaria, if we can get you on the right meds, almost everyone, almost everyone can get better. And if one medication doesn't work, we are so fortunate to have alternatives that work in different ways. So it's very great for patients, and we've made huge progress.
SPEAKER_02Well, and I think that's you know, hope for those patients, like we said earlier, that get out there and you know, let your dermatologists know you don't need to go to allergy. If you're looking to refer, send a dermatology so we can get these patients treated and get their hives under control. So thank you so much for coming on the podcast, Walter. It was great to have you here today.
SPEAKER_00Thank you so much for having me. I appreciate it.
SPEAKER_02And stay tuned for the next episode of Dermitrotter Don't Swear About Skin Care.
SPEAKER_01Thanks for listening to Dermotrotter. For more about skincare, visit dermitrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.
