psychological stress urticaria

Psychological stress urticaria is a special type of urticaria induced by emotional stress. It is classified as a subtype of cholinergic urticaria. The correlation between attacks and acute anxiety and long-term high pressure is 72%. It is non-infectious. After symptomatic intervention and emotional adjustment, 85% of patients can achieve long-term relief within 3 months without leaving skin scars or permanent health damage.

Last month, I met a junior girl in the outpatient clinic. When she opened the door, her sleeves were pulled up to her elbows, and her forearms were covered with light red wheals. It was so itchy that she couldn't sit still and kept rubbing against the chair. A full set of allergens had been checked in other hospitals before, and the results were negative for dust mites, seafood, and pollen. The prescribed loratadine disappeared immediately after taking the medicine, and the medication lasted on time the next day. When I asked, I found out that she was preparing for the postgraduate written examination. She stayed up all night for three weeks in a row. Last week, she had some unpleasant troubles with her tutor. She hid in bed and cried until three in the morning, and the next day she started to develop a rash. I didn't prescribe her any other medicine, so I replaced the previous antihistamine with the faster-acting desloratadine, and asked her to take 20 minutes a day to walk around the playground instead of being bored in the library all day. I also suggested that she go to the school psychological center for counseling. As a result, she came for a follow-up visit last week and said that the rash had not appeared for half a month, she had passed the written test, and her complexion had brightened up several degrees.

Speaking of which, there are actually two different ways of dealing with this disease in dermatology. Most of the older generation of dermatology experts believe that "just treat the symptoms" and believe that no matter what the trigger is, the essence is that pressure stimulates the release of acetylcholine from nerve endings and induces the degranulation of mast cells to release histamine, which causes wheals and itching. Therefore, as long as you take second-generation antihistamines regularly to suppress symptoms, emotional problems do not require special intervention. I met an old professor when I was outpatient. He prescribed Ebastine for three months to an Internet programmer who had been having seizures for three consecutive months. He was asked to take one tablet a day. It was true that he did not have seizures while taking the medicine. However, after stopping the medication, he immediately relapsed as soon as he worked overtime on a project. He continued on and off for almost a year. Nowadays, more and more doctors in the field of psychosomatic medicine are more inclined to "tracing the source of intervention", believing that this is actually a "stress warning signal" sent by the body - your emotions are overloaded, and if you don't adjust, there will be bigger problems. Simply relying on drugs to suppress symptoms will only treat the symptoms but not the root cause. The programmer I mentioned just now was transferred to the psychosomatic department for follow-up. He forced himself to cut his working hours from 120 hours per week to 90 hours, set aside two nights a week to play badminton, and practiced mindful breathing for half a month. Now, even if he occasionally stays up until one or two o'clock on projects, he has never done it again.

Many people think that their "immunity is low" when they get a rash, so they turn around and buy protein powder, vitamins, sea cucumbers and other supplements. It is really unnecessary. Stress urticaria is not a low immunity at all, but an immune regulation disorder caused by stress. If you take supplements indiscriminately, it may aggravate the immune disorder. I met a patient before who took two sea cucumber supplements every day during the attack. Originally, he only had a rash on his waist and abdomen. After a week of supplementation, it was all over his face. After stopping the supplement, most of it disappeared within two days. Some people also asked whether they should check for allergens? Unless you are also sure that you have touched something you have never touched before, there is really no need. 90% of patients with pressure urticaria allergen tests are negative, which is a waste of money.

It's quite interesting to say that I also had a growth spurt in the two weeks when I was rushing to declare for natural causes last year. A light red wheal developed near my collarbone. It was so itchy that I couldn't help but scratch it while I was typing. I couldn't sit still at all. I knew that I had been suffering from too much stress lately, and I didn't take any medicine. I changed my shoes and ran downstairs for three kilometers. I was sweating all over. I went home and took a warm shower. I went to bed early. When I woke up the next day, the rash was completely gone, without even leaving any marks. You see, in fact, many times your body knows better than you yourself whether you can bear it or not. To put it bluntly, a rash is the body shouting at the top of its lungs to "get some rest and stop stretching."

Of course, it doesn’t mean that everyone should just bear it when they have an attack. If you are itching so much that you can’t sleep, or even have chest tightness and throat tightness, you still have to take medicine. Second-generation antihistamines have very small side effects. Most people will not feel sleepy or hurt their liver or kidneys after taking them. There is no need to bear the pain. In the final analysis, this disease is not a serious illness, it is just a bit annoying. Every attack is a reminder: Have you been too harsh on yourself recently? There is no need to risk everything. Eat a good meal, complain to your friends for half an hour, or even go shopping for half an hour. It may be more effective than any special medicine.