Chronic urticaria: pathophysiology and treatment approaches

Area of Science:

• Dermatology
• Immunology
• Pathology

Background:

• Urticaria presents diverse clinical and histopathological features.
• Chronic urticaria frequently lacks an identifiable cause, often classified as idiopathic.
• Dermal mast cells and their mediators are implicated in chronic idiopathic urticaria pathogenesis.

Purpose of the Study:

• To explore the role of inflammatory cells in urticaria.
• To guide treatment strategies based on cellular infiltrates.
• To review current therapeutic approaches for chronic urticaria.

Main Methods:

• Histopathological examination of skin lesions to identify inflammatory cell types.
• Clinical correlation of cellular infiltrates with treatment response.
• Review of pharmacological interventions targeting histamine and inflammatory cells.

Main Results:

• Lymphocyte-predominant urticaria often responds to H1 antihistamines, including newer non-sedating options.
• Urticaria with predominant polymorphonuclear neutrophils may require additional therapies like colchicine or dapsone.
• Systemic corticosteroids may be used briefly but long-term use is discouraged due to adverse effects.

Conclusions:

• Treatment of chronic urticaria should be tailored to the specific inflammatory cell profile.
• Targeting histamine and polymorphonuclear neutrophil function is crucial for refractory cases.
• Further understanding of pathophysiologic mechanisms may lead to more effective therapies for chronic urticaria.