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Dear Editor, Chronic urticaria (CU) is a debilitating dermatological condition characterized by transient, pruritic wheals and/or angioedema lasting over six weeks. Its impact extends beyond physical symptoms, significantly impairing quality of life (QoL) and mental health. In India, where the burden of CU is growing, understanding the multifaceted impact of the disease is crucial for targeted management strategies.1 The aim of this study was to evaluate QoL, mental well-being, and disease activity in patients with CU using the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), Hospital Anxiety and Depression Scale (HADS), and Urticaria Activity Score (UAS-7), respectively, and to examine correlations between these parameters. We conducted a cross-sectional, observational study involving 67 patients with CU attending the dermatology outpatient department at a tertiary care centre in South India from September 2023 to May 2024, after obtaining institutional ethical clearance (Yenepoya Ethics Committee 2, approval number YEC2/2023/147, 12/08/2023). Patients were assessed using the CU-Q2oL and HADS. Disease activity was evaluated using UAS-7, and correlations between these parameters were analysed. Our findings revealed a mean CU-Q2oL score of 72.36 ± 20.64, indicating a considerable impact on patients’ daily lives. Females reported higher scores than males (76.75 ± 20.61 vs. 63.96 ± 18.32; P = 0.014), reflecting greater perceived burden among women. Table 1 summarizes the demographic characteristics of the study participants, illustrating notable gender differences. Sleep disturbances and limitations in daily activities were the most affected domains, consistent with previous studies highlighting the prominence of sleep problems in CU patients.2,3 Poor sleep quality often triggers fatigue and impairs productivity, further compounding the QoL deficit Table 2.Table 1: Demographics of the participants (n=67)Table 2: Number of domains and questions in CU-Q2oL questionnaire 6 Anxiety and depression were prevalent, with 29.9% and 22.4% of patients exhibiting abnormal levels, respectively. Anxiety showed a significant correlation with disease activity (P = 0.011), suggesting a bidirectional relationship where psychological distress may exacerbate urticaria activity through heightened immune and inflammatory responses.4 This underscores the importance of incorporating psychological support into CU management. However, our study found no significant correlation between CU-Q2oL scores and UAS-7 (P = 0.372), aligning with other research that suggests QoL impairment in CU is not solely determined by physical symptom severity but also by the psychological and social dimensions of the disease.1,5 Interestingly, despite the availability of systemic medications, many patients reported inadequate disease control, potentially reflecting gaps in treatment adherence or suboptimal therapeutic regimens. Females reported higher CU-Q2oL scores, possibly due to greater sensitivity to the emotional impact of the disease, while males demonstrated higher UAS-7 scores, indicative of more severe physical symptoms. This gender-based variation highlights the need for individualized care plans addressing both physical and emotional aspects of the disease. Our findings also revealed the significant impact of mental health on disease burden. Depression and anxiety scores strongly correlated with CU-Q2oL scores (P < 0.001 and P = 0.001, respectively), reinforcing the need for regular mental health assessments in CU patients. Addressing psychological comorbidities could improve overall disease outcomes and QoL. Sleep disturbances, often overlooked in clinical practice, are a critical concern. Targeted interventions to improve sleep quality, such as cognitive behavioural therapy or pharmacological support, could significantly enhance patients’ overall well-being. These findings align with growing evidence that prioritizes sleep quality in the management of chronic skin conditions.3 Figure 1 highlights the correlations between CU-Q2oL, UAS-7, anxiety, and depression scores, illustrating the intricate interplay between physical and psychological factors in CU. It is evident that mental health assessments should be integral to CU management, with interventions targeting anxiety and depression likely to yield better clinical outcomes.Figure 1: Correlation of overall score between: (a) UAS-7 score and CU-Q2oL total score, (b) UAS-7 score and depression score, (c) UAS-7 score and anxiety score, (d) CU-Q2oL total score and depression score, (e) CU-Q2oL total score and anxiety scoreWhile this study offers valuable insights, it has limitations. These include a small sample size of 67 patients, which limits generalizability, and the use of self-reported measures like CU-Q2oL and HADS, which may also introduce subjectivity. Future research should involve larger, multicentre studies to validate these findings and explore regional variations, especially in culturally diverse populations like in India. The significant burden of CU on QoL and mental health calls for a holistic management approach. Dermatological care should incorporate psychological assessments, focusing on anxiety and sleep disturbances, which are key contributors to disease burden. Integrated care combining dermatological treatment with mental health support can effectively address the multifaceted challenges of CU, improving patient outcomes and quality of life. Chronic urticaria extends beyond being a dermatological condition, impacting patients’ mental and emotional well-being. It requires a multidisciplinary approach that integrates medical therapy with psychosocial support to address its physical, emotional, and social dimensions. This study highlights the urgent need for tailored care strategies for Indian CU patients, who often face challenges such as limited access, awareness, and treatment adherence. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies.
Anjum et al. (Thu,) studied this question.