Chronic Spontaneous Urticaria Linked to Higher Patient Burden, Worse Quality of Life

Chronic spontaneous urticaria places a heavier burden on patients than atopic dermatitis and psoriasis, leading to a worse quality of life and higher health care costs and underscoring the critical need for better treatments. | Image Credit: StockWorld - stock.adobe.com

Patients with chronic spontaneous urticaria (CSU) face a higher humanistic and economic burden, including worse quality of life and greater health care utilization, compared with those with atopic dermatitis and psoriasis, emphasizing the need for new treatments and improved clinical management, according to an article published in the Journal of Dermatological Treatment.¹

CSU, atopic dermatitis, and psoriasis are common inflammatory skin conditions that significantly impact patients' quality of life (QOL). While psoriasis management has advanced with a variety of systemic therapies, including traditional options such as methotrexate, cyclosporine A, and acitretin, these older treatments often come with notable limitations.²

Similarly, the standard of care for atopic dermatitis involves topical corticosteroids and moisturizers, though newer treatments such as dupilumab (Dupixent; Regeneron Pharmaceuticals and Sanofi) and Janus kinase inhibitors are emerging.³ Effective management of atopic dermatitis also requires clear, simple treatment plans to ensure patient adherence, including proactive treatment and trigger reduction to minimize flare-ups.

Repurposed biologics for other conditions have generally failed to treat urticaria, with the notable exception of dupilumab, which is now approved for patients whose chronic spontaneous urticaria is not well-managed by standard antihistamines.⁴ For patients with autoimmune-related urticaria, a biopsy showing neutrophilic infiltrates may indicate they would respond better to medications such as dapsone, hydroxychloroquine, or colchicine rather than antihistamines or omalizumab (Xolair; Novartis Pharmaceuticals and Genentech).

Patients with CSU often face significant socioeconomic burdens, including high health care costs and lost productivity, due to their limited treatment options. To compare these burdens, researchers used real-world data from the 2019 US National Health and Wellness Survey (NHWS).¹

From a total of 74,994 survey respondents, the study identified 371 individuals with CSU, 549 with atopic dermatitis, and 2061 with psoriasis. The findings revealed that patients with CSU were significantly younger, with a mean age of 41.7 years, than those with atopic dermatitis or psoriasis.¹

Women made up a larger proportion of respondents with atopic dermatitis (76.1%) than those with CSU (59.8%) or psoriasis (57.3%) (P < .001). The CSU group had the highest rates of full-time employment and university degrees. However, they were the least likely to be currently receiving treatment, with a lower proportion of treated patients compared with the atopic dermatitis and psoriasis groups (54.2% vs 72.5% and 68.3%, respectively; P < .001).¹

Patients with CSU reported a significantly worse health-related QOL than those with atopic dermatitis or psoriasis. All 3 groups had mental and physical health scores that were lower than the general US population norm of 50. However, the CSU cohort consistently had the lowest scores. For example, their average mental component summary (MCS) score was 41.3 and their physical component summary (PCS) score was 42.1, both of which were statistically lower than the scores for patients with atopic dermatitis (MCS 44.8; PCS 47.8) and psoriasis (MCS 45.3; PCS 47.7).¹

The study found that CSU had a greater impact on QOL than either atopic dermatitis or psoriasis. Specifically, the dermatology-related QOL score for CSU was 9.4, which was more than double the scores for atopic dermatitis (4.0) and psoriasis (3.5). Further, a larger proportion of respondents with CSU reported symptoms of mild to severe anxiety and depression.¹

Patients with CSU experienced significantly greater work- and non-work-related activity impairment compared with those with atopic dermatitis and psoriasis. The average percentage of work time missed was nearly 3 times higher for the CSU group (19.9%) than for the AD (7.2%) and PSO (7.3%) groups (P < .001 for both).¹

A higher percentage of patients with CSU reported visiting a health care provider compared with those with psoriasis (97.3% vs 92.8%). The study also found that patients with CSU were more than twice as likely to visit an emergency room and over 3 times more likely to be hospitalized in the past 6 months than those with atopic dermatitis (AD) or PSO. All of these differences were statistically significant.¹

This study's findings have several limitations common to internet-based surveys. The results may be skewed by selection bias, as some groups have limited internet access, and by response bias from voluntary participation. Additionally, the data rely on self-reporting, which can be inaccurate, and the cross-sectional design prevents the study from establishing cause and effect.¹

“Our study shows that CSU, atopic dermatitis, and psoriasis all impair patient quality of life, and CSU may generate the highest impairment if inadequately controlled,” study authors concluded.¹

References

1. Soong W, Patil D, Rodrigues J, et al. Burden of chronic spontaneous urticaria relative to atopic dermatitis and psoriasis in the United States. J Dermatol Treat. 2025;36(1). doi:10.1080/09546634.2025.2517384
2. Ponikowska M, Vellone E, Czapla M, Uchmanowicz I. Challenges psoriasis and its impact on quality of life: challenges in treatment and management. Psoriasis (Auckl). 2025;15:175-183. Published 2025 May 1. doi:10.2147/PTT.S519420
3. Schoch JJ, Anderson KR, Jones AE, et al. Atopic dermatitis: update on skin-directed management: clinical report. Pediatrics. Published online May 19, 2025. doi:10.1542/peds.2025-071812
4. Santoro C. Personalizing urticaria treatment through the evolving role of biomarkers and biopsies. The American Journal of Managed Care^®. July 8, 2025. Accessed August 5, 2025. https://www.ajmc.com/view/personalizing-urticaria-treatment-through-the-evolving-role-of-biomarkers-and-biopsies