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Psychogenic urticaria: The issues of diagnosis and optimization of therapy

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Objective: to reveal clinical and immunological criteria for psychogenic urticaria (PU) and to determine the therapeutic efficacy of alimemazine in this abnormality.

Patients and methods. Ninety-three patients with PU, 46 apparently healthy individuals, and 90 patients with chronic autoimmune urticaria (CAU) were examined. The methods included clinical examination; use of the Goldberg anxiety rating scale; enzyme immunoassay of serum substance P levels. The efficacy of alimemazine was evaluated in an open-label comparative randomized trial for 4 weeks.

Results and discussion. Patients with PU significantly more frequently showed a predominance of manifestations of itching over skin rashes and higher levels of anxiety disorders than those with CAU. The mean serum concentration of substance P was 0.006±0.005 ng/ml in the patients with CAU, 0.026±0.02 ng/ml in healthy individuals, and 8.46±0.95 ng/ml in the patients with PU (p<0.0001). Addition of standard therapy (second-generation antihistamines, disintoxication) with alimemazine 15–30 mg/day ensured statistically significant advantages over the control (standard therapy) in the following indicators: reductions in the severity of the disease, the degree of anxiety disorders, and the serum levels of substance P. Alimemazine was noted to be satisfactorily tolerated. Thus, the authors established the following diagnostic criteria for PU: a psychotraumatic situation; dermal manifestations after psychogeny; high anxiety; a predominance of the manifestations of itching over the dermal symptoms of urticaria; and elevated serum substance P concentrations. Standard therapy added by alimemazine versus that without the drug was found to be effective. There were reductions in the symptoms of urticaria, the degree of anxiety disorders, and the levels of substance P.

About the Authors

A. A. Pribytkov
Penza Institute for Postgraduate Training of Physicians, Ministry of Health of Russia
Russian Federation

Penza, Russia 8A, Stasov St., Penza 440060

E. A. Orlova
Penza Institute for Postgraduate Training of Physicians, Ministry of Health of Russia
Russian Federation
Penza, Russia 8A, Stasov St., Penza 440060


1. Смулевич АБ, Иванов ОЛ, Львов АН, Дороженок ИЮ. Психодерматология: современное состояние проблемы. Журнал неврологии и психиатрии им. С.С. Корсакова. 2004;104(11):4–14. [Smulevich AB, Ivanov OL, L'vov AN, Dorozhenok IYu. Psychodermatology: current state of a problem. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2004;104(11):4–14. (In Russ.)]

2. Harth W, Gieler U, Kusnir D, Tausk FA. Clinical management in psychodermatology. Berlin: Springer; 2009. 297 p.

3. Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry. 2007;9(3):203–13. DOI:

4. Guillet G, Garcia C, Guillet MH. Urticaire et psychisme: du constat clinique aux neuropeptides. Revue Francaise d’Allergologie et d’Immunologie Clinique. 1998;38(4):401–14. DOI:

5. Gupta M, Gupta A. Psychodermatology: an update. J Am Acad Dermatol. 1996;34(6):1030–46. DOI:

6. Sachdeva S, Gupta V, Amin SS, Tahseen M. Chronic urticarial. Indian J Dermatol. 2011;56(6):622–8. DOI: 10.4103/0019-5154.91817.

7. Гребенченко ЕИ, Гущин ИС, Феденко ЕС. Механизм кожного зуда при атопическом дерматите. Российский аллергологический журнал. 2009;(3):3–12. [Grebenchenko EI, Gushchin IS, Fedenko ES. Mechanisms of itch in atopic dermatitis. Rossiiskii allergologicheskii zhurnal. 2009;(3):3–12. (In Russ.)]

8. Султанова НГ. Анализ межсистемного взаимодействия ряда нейроиммунных показателей при атопической бронхиальной астме у детей. Цитокины и воспаление. 2011;10(1):18–23. [Sultanova NG. Analysis of some neuroimmune interactions in children with atopic asthma. Tsitokiny i vospalenie. 2011;10(1):18–23. (In Russ.)]

9. Broom BC. A reappraisal of the role of «mindbody» factors in chronic urticarial. Postgrad Med J. 2010;86(1016):365–70. DOI:10.1136/pgmj.2009.096446.

10. Foreman JC. Substance P and calcitonin gene-related peptide effect on mast cells and in human skin. Int Arch Allergy Appl Immunol. 1997;82(3–4):366–71.

11. Luger TA, Lotti T. Neuropeptides: role in inflammatory skin diseases. J Eur Acad Dermatol Venereol. 1998;10(3):207–11. DOI: 3083.1998.tb00736.x.

12. Pincelli C, Fantini F, Giannetti A. Neuropeptides and skin inflammation. Dermatology. 1993;187(3):153–8. DOI:

13. Liezmann C, Klapp B, Peters EM. Stress, atopy and allergy: a re-evaluation from a psychoneuroimmunologic persepective. Dermatoendocrinol. 2011;3(1):37–40. DOI: 10.4161/derm.3.1.14618.

14. Singh LK, Pang X, Alexacos N, et al. Acute immobilization stress triggers skin mast cell degranulation via corticotropin releasing hormone, neurotensin, and substance P: a link to neurogenic skin disorders. Brain Behav Immun. 1999;13(3):225–39. DOI:

15. Arck P, Paus R. From the brain-skin connection: the neuroendocrine-immune misalliance of stress and itch. Neuroimmunomodulation. 2006;13(5–6):347–56. DOI: Epub 2007 Aug 6.

16. Panconesi E, Hautmann G. Psychophysiology of stress in dermatology. The psychobiologic pattern of psychosomatics. Dermatologic Clin. 1996;14(3):399–421. DOI: 8635(05)70368-5.

17. Ebner K, Muigg P, Singewald G, Singewald N. Substance P in stress and anxiety: NK-1 receptor antagonism interacts with key brain areas of the stress circuitry. Ann N Y Acad Sci. 2008;1144:61–73. DOI: 10.1196/annals.1418.018.

18. Ebner K, Singewald N. The role of substance P in stress and anxiety responses. Amino Acids. 2006;31(3):251–72. DOI: 0335-9. Epub 2006 Jul 6.

19. McLean S. Do substance P and the NK1 receptor have a role in depression and anxiety? Curr Pharm Des. 2005;11(12):1529–47. DOI:

20. Goldberg D, Bridges K, Duncan-Jones P, Grayson D. Detecting anxiety and depression in general medical settings. BMJ. 1988;297(6653):897–9. DOI:

21. Крапивница и ангиоотек. Рекомендации для практических врачей. Российский национальный согласительный документ. Москва: Фармарус Принт Медиа; 2007. С. 8–9. [Small tortoiseshell and angiootek. Rekomendatsii dlya prakticheskikh vrachei. Rossiiskii natsional'nyi soglasitel'nyi document [Recommendations for practical doctors. Russian national conciliatory document]. Moscow: Farmarus Print Media; 2007. P. 8–9.]

22. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–5. DOI:

23. Ибрагимов ДФ. Алимемазин во врачебной практике. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;108(9):76–8. [Ibragimov DF. Alymemazine in medical practice. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2008;108(9):76–8. (In Russ.)]

24. Krause L, Shuster S. Mechanism of action of antipruritic drugs. Br Med J (Clin Res Ed). 1983;287(6400):1199–200. DOI:

25. Mohammadi R, Gaudoneix-Taieb M, Armand-Branger S, et al. Value of trimeprazine among hypnotics in a psychiatric facility. Encephale. 2000; 26(5):75–80.

For citation:

Pribytkov A.A., Orlova E.A. Psychogenic urticaria: The issues of diagnosis and optimization of therapy. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(3):21-26. (In Russ.)

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