Turkish dermatologists' approach for chronic spontaneous urticaria: A questionnaire based study

Abstract

Background/Objectives: Chronic spontaneous urticaria (CSU) is a common skin disorder which represents a challenge both for the patients and physicians. Guidelines and treatment algorithms have been created to help physicians to ease management. Our aim was to determine Turkish dermatologists' approach to CSU with regard to treatment, search for causative factors and use of instruments to assess the quality of life and severity of the disease. Methods: This was a cross-sectional methodological study which was performed by delivery of a questionnaire including ten questions about the management of CSU. Results: Analyses of 314 questionnaires revealed that the most common first-line treatments were non-sedating antihistamines in standard doses (65.6%), while second-line treatment was updosing antihistamines (59.9%) followed by addition of sedative-antihistamines (26.4%) and systemic steroids (19.1%). Third-line treatment option was omalizumab in 35% followed by systemic steroids. Twenty-two percent of the dermatologists referred the patients to a center experienced in urticaria. Most of them were performing laboratory testing for underlying causes including thyroid function tests, C-reactive protein, thyroid auto-antibodies, stool analyses, infection markers. Urticaria activity score and chronic urticaria quality of life questionnaire were used by 30 and 13%, respectively, while 56% were using none of the instruments. Conclusion: Our study showed that the therapeutic management of Turkish dermatologists was parallel to the European Urticaria Guidelines. The high utility of omalizumab as a third line regimen improved patient care. Nevertheless there is a need for centers experienced in urticaria to refer antihistamine-resistant patients where third-line treatment options can not be implemented. Keywords: Urticaria, Dermatologists, Therapeutics, Diagnosis, Guideline