Chronic spontaneous urticaria, also known as CSU, shares many symptoms and side effects with other skin diseases. But it can affect your emotional and mental health more than others do.
"Like other chronic skin conditions, it can interfere with sleep, daily routines, and social life, especially because it’s visible and often itchy," says Bruce Brod, MD, MHCI, FAAD. He’s a clinical professor of dermatology and director of contact dermatitis and occupational dermatology at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
CSU brings other issues that can make mental stress more acute, though. "There’s growing evidence that CSU is linked to higher rates of anxiety and depression compared to many other skin diseases," Brod says.
A research analysis that compared 12 studies found people who have CSU are six times more likely to have anxiety and depression than people who don’t. The severe itching, hives, and swelling that show up without warning can impact your body image, self-esteem, and social life.
The good news is CSU is highly treatable, especially with new meds that can be better at easing symptoms that affect your mental health. And you don’t have to make the journey alone.
Seek Out Support
It’s best to see a specialist – a dermatologist or an allergist – to diagnose and help you navigate CSU. "It’s important to work with a physician experienced in CSU" to ensure you’ll get the right support, Brod says.
"In my clinic, we ask screening questions to check for signs of anxiety or depression. Things like trouble sleeping, feeling overwhelmed, or avoiding social situations can be red flags," he says.
Some patients benefit from support groups or behavioral health referrals, Brod says. "Know that you’re not alone, and there are effective treatments. Managing stress, getting good sleep, and working with a physician-led care team that understands CSU can make a big difference."
Scope out support from groups near you or on the internet.
Social media can be a fruitful place to network, too. Aside from getting emotional support, you can find new strategies to improve symptoms and make living with CSU easier. Be sure to check with your specialist before trying anything new, though. There’s not only a lot of misinformation out there, but your doctor knows your history and personal treatment plan for CSU.
Get a referral to a mental health professional.
Your provider can help steer you toward a therapist or counselor who can provide needed emotional support and help with depression, anxiety, or stress that can come with CSU. If insurance doesn’t cover it, check out options online and organizations that offer mental health services on a sliding scale based on your income.
Build up your friends-and-family network.
Not everyone has to know all about CSU to lend supportive energy. If your circle could use some widening, take a class, volunteer, join a gym, or find an interesting hobbyist club.
Manage Stress in New Ways
The seeming randomness of CSU outbreaks and lack of a clear cause are two things that can make CSU especially stressful, Brod says. Not knowing when symptoms might show up can make you anxious, disrupt your schedule, and more.
"CSU is unpredictable, and there’s often no single trigger," he says. "It can be frustrating, especially when patients want to find a cause like a food or allergy." Understanding that it’s a chronic condition, and not always allergy-related, is key.
Like other conditions, stress can make it harder to manage. "In some patients, stress can make symptoms worse," Brod says. "That’s true for many chronic skin conditions. It doesn’t cause the disease, but it can make it harder to manage."
Stress busters that might be familiar to you but can help improve your sense of well-being with CSU include:
Move to feel good.
Releasing endorphins helps you mentally and physically. Enjoyable exercise like taking nature walks or dancing can be more healing and better for clearing your mind than a competitive sport when you’re already stressed, for example.
Try new things.
Whether it’s learning a song on the ukulele, visiting another country, or learning how to boil the perfect egg, novel activities can give you things to look forward to, keep your mind off stress and discomfort, and help you lean into the positive.
Find something to nurture.
It can be a fish, a kitten, a kitchen garden, or a simple houseplant. Taking care of other living things can be excellent self-care. Choose something easy that won’t get too frustrating, though.
Focus on sleep quality.
A bedtime routine can help you get better rest. For example, try taking a relaxing warm bath or shower before you turn in. And banish electronics – not only the TV, but your cellphone – from your bedroom.
'A Treatable Condition'
"This is a treatable condition," Brod says. "I usually start with second-generation antihistamines. If those aren’t enough, there are newer medications, including biologics."
The FDA recently approved the drug dupilumab (Dupixent) as a first-line treatment for CSU, the first targeted therapy for CSU to come along in more than 10 years. Studies show the drug eases severe itching and cuts down hives outbreaks, making it a potential game changer for people whose CSU hasn’t responded to standard treatments.
Another option is omalizumab (Xolair). It’s a type of drug known as a monoclonal antibody. It works by targeting certain substances called immunoglobulin E (IgE) antibodies, which may trigger hives. Your doctor may also suggest trying corticosteroids, antihistamines, or cyclosporine, mycophenolate mofetil (CellCept), and tacrolimus (Prograf). These all work to try to calm down your immune system.
You might also think about adding alternative therapies to your toolbox. Practices such as mindfulness and meditation have been shown to make a big difference in stress, anxiety, and body acceptance for people with chronic conditions such as CSU.
Show Sources
Photo Credit: Tetra images/Getty Images
SOURCES:
Bruce A. Brod, MD, MHCI, FAAD, clinical professor of dermatology and director of contact dermatitis and occupational dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Allergy & Asthma Network: "Chronic Hives: 10 Actions to Support Your Mental Health."
Frontiers in Psychiatry: "Association of Chronic Spontaneous Urticaria With Anxiety and Depression in Adolescents: A Mediation Analysis."
Cleveland Clinic: "Chronic Hives and Mental Health: Self-Care Tips."
Dermatology Times: "FDA Approves Dupilumab for Adolescents and Adults With H1
Antihistamine-Refractory Chronic Spontaneous Urticaria."
UpToDate: "Chronic spontaneous urticaria: Standard management and patient education," "Chronic spontaneous urticaria: Treatment of refractory symptoms."
