Chronic idiopathic urticaria is an allergic disease characterized by itchy rash and edematous papules- plaques that are ongoing at least six weeks. In addition, there are studies suggesting that psychosocial factors and emotional stress play a role in the development and exacerbation of disease. Urticaria is one of dermatological diseases which the psychiatric co-morbidity frequently seen. In these patients, depression, anxiety and somatoform disorders are thought to have increased prevalence and this situation has a serious impact on the quality of life. Emotional stress may even initiates or exacerbates urticaria. Two patients with first episode of urticaria during premenopause and diagnosed with anxiety disorder after the psychiatric examination were examined in this report.
Case A: Fifty-five year-old female patient was admitted to the psychodermatology polyclinic with itching in the hands and face, swelling and redness complaints. According to the medical history, complaints first initiated four years ago when the patient was in pre-menopausal period and had intense familial problems. Psychiatric consultation was requested due to the triggering of the disease by stress. After the psychiatric and dermatological interviews, this patient was diagnosed as “Chronic urticaria” and “generalized anxiety disorder”. Patient was resistant to dermatological treatments. Sertraline 50 mg/day was added. Both psychiatric and dermatological complaints and findings (Beck Anxiety Inventory, State-Trait Anxiety Inventory, Urticaria Activity Score) had been found to decrease in the control examination after 6 weeks.
Case B: Fifty year-old female patient was admitted to the psychodermatology polyclinic with itching, swelling and redness on the body. Dermatologic complaints had been started simultaneously with the anxiety secondary to social issues in premenopausal period. Chronic urticaria was diagnosed to the patient after the dermatologic examination. Anti-allergic treatment was started and respond to this treatment was received. Psychiatric consultation was requested because of the anxiety of the patient during the examination. As a result of the psychiatric interviews and psychometric evaluations (SCID-I, Beck Anxiety Inventory, State-Trait Anxiety Inventory), this patient was diagnosed as generalized anxiety disorder and escitalopram 20 mg/day treatment was started. In the control examinations, decline in dermatological and psychiatric problems were observed. Urticaria is known to be in close relationship with emotional state. These cases suggest that the close relationship between urticaria and emotional state may be much more important in premenopausal period. Consequently, consideration of psychological factors and emotional şuctuations brought about by the current period are expected to increase treatment success and patient satisfaction in the evaluation of patients with chronic urticaria.