Psychodermatology of Chronic Urticaria

Abstract

Introduction: Chronic spontaneous urticaria (CSU) significantly impairs quality of life. This review synthesizes evidence on psychiatric comorbidities and psychopharmacological interventions. Methods: Systematic review of 31 studies (n=8,742 CSU patients). Standardized psychiatric interviews and validated scales (HADS, DLQI) were used. Results: Prevalence of any anxiety disorder was 34%, major depression 22%. Suicidal ideation reported in 6%. First-generation antihistamines worsened cognitive symptoms. Low-dose doxepin (10-25mg) reduced both urticaria activity score (UAS7 reduction 58%) and anxiety. Discussion: Bidirectional relationship: histamine affects central nervous system; stress activates mast cells. Most interventional studies lacked placebo control. Conclusions: Psychiatric screening is essential in CSU. Doxepin may address both skin and mood symptoms but requires monitoring for sedation.