Urticaria Comes Home: Diagnosis, Treatment, and Empowerment in Derm Practice

At the Masterclasses in Dermatology APP Institute, David Rosmarin, MD, made a confident case for dermatology owning the urticaria conversation in his session, “Urticaria Finds Its Way Home to Dermatology.” With practical guidance and updated treatment options, Rosmarin equipped APPs to recognize and manage a broad range of urticaria types.

“It could be you!” he told attendees, reminding them that patients often land in dermatology clinics first.

Dr Rosmarin opened with a breakdown of acute vs chronic urticaria, highlighting that acute cases, which are often triggered by infections, foods, or medications, are usually short-lived. In contrast, chronic urticaria persists beyond 6 weeks and includes both chronic spontaneous urticaria (CSU) and chronic inducible urticaria. The latter may stem from triggers like cold, pressure, heat, or vibration.

“Identification of a cause is rare (<5%),” he said of CSU, which is more common in adults and affects women more than men.

Dr Rosmarin emphasized that extensive testing is not always necessary.

“Most of the time labs are not indicated,” he noted, recommending a focused panel only in certain cases, such as complete blood cell count, C-reactive protein, erythrocyte sedimentation rate, total IgE, thyroid-stimulating hormone, and tryptase, depending on the clinical picture.

He also cautioned against unnecessary testing, stating plainly, “Patients with CSU do not need prick tests, patch tests, food allergy testing, or skin biopsy.”

“First-line treatments are antihistamines,” Dr Rosmarin advised, adding that doses can be increased up to fourfold if needed. For patients who remain symptomatic, options include:

• Omalizumab, with 60% seeing symptom reduction by week 12
• Dupilumab is approved for CSU
• Immunosuppressants like cyclosporine or dapsone in refractory cases
• And newer options like remibrutinib, an oral Bruton's tyrosine kinase inhibitor, showing symptom relief within 1 week

With misdiagnosis still common and quality of life heavily impacted, Dr Rosmarin urged APPs to take the lead in urticaria care.

“Urticaria is a burden. Sudden, recurrent symptoms can be debilitating and disrupt sleep,” he said.

Reference

Rosmarin D. Urticaria finds its way home to dermatology. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.