The intermittent nature of chronic spontaneous urticaria (CSU) can lead to diagnostic and treatment delays, especially in patients with skin of color whose skin changes may not be as recognizable. Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Mona Shahriari, associate clinical professor of dermatology at Yale University School of Medicine, about the disease that she terms “the rash that ghosts you.” Learn her tips for appreciating CSU in patients with darker skin tones. Find out what’s new in the CSU tool box. Plus hear her recommendations for antihistamine management.
Further Reading
If you want to read more about chronic spontaneous urticaria, check out the following articles published in the Journal of Drugs in Dermatology:
From Research to Practice: The Latest Data on Evolving Treatments for Chronic Spontaneous Urticaria
ABSTRACT
Chronic spontaneous urticaria (CSU) should be on every dermatology practitioner’s radar. CSU is a skin disorder marked by wheals, angioedema, or both for more than 6 weeks. Patients with CSU experience unexplained, itchy wheals that appear and disappear, traveling around the body and lasting less than 24 hours per area. Angioedema accompanies wheals for up to 48 hours in around half of cases. CSU is a diagnosis of exclusion, relying heavily on patient history to differentiate CSU symptoms from other causes of urticaria or angioedema. But reassuringly, CSU has a simple diagnostic algorithm and a clear initial treatment path. First-line strategies include non-pharmacologic approaches, and second-generation antihistamines (2gAH) administered up to 4 times their standard dose. Omalizumab and cyclosporine (off-label) are second- and third-line options, respectively. However, many patients will continue to have CSU symptoms despite consistent maximum-dose treatment. Novel therapies, including biologic agents and small molecule drugs targeting mast cell activation and inflammatory mediators, show promise in treating CSU refractory to standard therapy. However, further research is needed to establish their efficacy and safety in clinical practice.
Drugs in Development for Chronic Spontaneous Urticaria
ABSTRACT
Chronic spontaneous urticaria (CSU) is a debilitating disease for which many patients are inadequately treated. However, recent advancements in our understanding of the disease pathophysiology allow us to develop therapies that are more effective for CSU. It may be possible in the future to select personalized treatments based on a patient’s autoimmune endotype. This paper reviews current knowledge on CSU pathogenesis and treatment. It also reviews data for drugs being developed for the treatment of CSU, as listed on ClinicalTrials.gov.
Did you enjoy this video interview? Find more here.