J Drugs Dermatol. 2024 Sep 1;23(9):795-806.
Chronic spontaneous urticaria (CSU) should be on every dermatology practitioner's radar. CSU is a skin disorder marked by wheals, angioedema, or both for more than 6 weeks. Patients with CSU experience unexplained, itchy wheals that appear and disappear, traveling around the body and lasting less than 24 hours per area. Angioedema accompanies wheals for up to 48 hours in around half of cases. CSU is a diagnosis of exclusion, relying heavily on patient history to differentiate CSU symptoms from other causes of urticaria or angioedema. But reassuringly, CSU has a simple diagnostic algorithm and a clear initial treatment path. First-line strategies include non-pharmacologic approaches, and second-generation antihistamines (2gAH) administered up to 4 times their standard dose. Omalizumab and cyclosporine (off-label) are second- and third-line options, respectively. However, many patients will continue to have CSU symptoms despite consistent maximum-dose treatment. Novel therapies, including biologic agents and small molecule drugs targeting mast cell activation and inflammatory mediators, show promise in treating CSU refractory to standard therapy. However, further research is needed to establish their efficacy and safety in clinical practice. J Drugs Dermatol. 2024;23:9(Suppl 2):s5-14.Access the CME Activity.
慢性自发性荨麻疹（CSU）应该是每位皮肤科医生都关注的疾病。CSU 是一种以风团、血管性水肿或两者同时存在超过 6 周为特征的皮肤疾病。CSU 患者会出现不明原因的、瘙痒的风团，这些风团会出现并消失，在身体周围游走，每个区域持续时间不到 24 小时。在大约一半的病例中，血管性水肿会伴随风团持续长达 48 小时。CSU 的诊断主要依赖于病史，通过排除其他引起荨麻疹或血管性水肿的原因来进行诊断。但令人欣慰的是，CSU 有一个简单的诊断算法和明确的初始治疗方案。一线治疗策略包括非药物治疗方法，以及将第二代抗组胺药（2gAH）的剂量增加至标准剂量的 4 倍。奥马珠单抗和环孢素（超适应证用药）分别是二线和三线治疗选择。然而，许多患者尽管接受了最大剂量的持续治疗，但仍会有 CSU 症状。新型疗法，包括针对肥大细胞激活和炎症介质的生物制剂和小分子药物，在治疗对标准治疗无反应的 CSU 方面显示出前景。然而，仍需要进一步的研究来确定它们在临床实践中的疗效和安全性。《皮肤病药物治疗杂志》。2024；23：9（增刊 2）：s5-14.获取 CME 活动。
