Background: Patients with chronic spontaneous urticaria often exhibit psychiatric comorbidities including depression that contribute to the impairment of their quality of life. How CSU and depression are linked isn't well-understood. Substance P has been shown to be increased in patients with CSU and is held to contribute to the pathogenesis of depression.Methods: We measured disease activity in 30 CSU patients without depression and 30 CSU patients with depression by using the urticaria activity score. The severity of depression was assessed with the Beck Depression Inventory. We measured SP levels in these patients as well as in 30 healthy control subjects. In patients with comorbid depression, we correlated SP levels with CSU disease activity and the severity of depression.Results: In CSU patients, disease activity and the severity of depression were positively linked. UAS7 values were higher in CSU patients with comorbid depression as compared to those without (p < 0.05). SP levels were higher in CSU patients with depression than in those without (p < 0.001), but was similar in all CSU patients compared to healthy controls. SP levels weren't correlated with UAS7 values in CSU patients with depression, whereas they were weakly but significantly correlated with BDI scores (p < 0.05).Conclusion: Our results suggest that, in CSU patients with comorbid depression, CSU disease activity affects the severity of depression. CSU patients with high disease activity should be explored for comorbid depression.

Urticarial vasculitis is an eruption characterized by inflamed itchy or painful red papules or plaques that resemble urticaria but last longer than 24 hours and heal with residual pigmentation or purpura. Histopathologically, urticarial vasculitis presents as leukocytoclastic vasculitis with perivascular infiltrate and fibrin deposits. The treatment options are oral antihistamines, oral corticosteroids, dapsone, colchicine and hydroxychloroquine. We report four cases with normocomplementemic urticarial vasculitis who were treated with omalizumab and a brief review of the literature on the use of omalizumab in normocomplementemic urticarial vasculitis.

BackgroundVarious studies have reported different results for cortisol, dehydroepiandrosterone sulfate (DHEA-S) and 25-hydroxyvitamin D (25(OH)D) levels in patients with chronic spontaneous urticaria (CSU) and these were not sufficient for explaining the underlying reasons.ObjectivesTo evaluate the levels of cortisol, DHEA-S and 25(OH)D in patients with CSU and to investigate the relationships between these parameters.MethodsFifty patients who had diagnosed with CSU and 30 healthy controls were enrolled into the study. Stress levels of CSU and control groups were determined by perceived stress scale (PSS-14). The activity of urticaria of the patients was also determined by urticaria activity score (UAS7). Serum DHEA-S, cortisol and 25(OH)D levels of the participants were measured and compared.ResultsDHEA-S and 25(OH)D levels of CSU patients were lower than the control group (p<0.001 and p<0.001, respectively) while stress level and cortisol/DHEA-S ratio were higher (p<0.001 and p=0.003, respectively).ConclusionsLower 25(OH)D levels and higher cortisol/DHEA-S ratio in CSU patients who have higher stress level indicate that the level of 25(OH)D seems to be associated with steroidogenesis and thus 25(OH)D levels may decrease secondarily in CSU.

AIM: To evaluate vitamin D levels in patients with chronic spontaneous urticaria (CSU), depression and both of them, thus to fi nd out whether vitamin D may be a common causative factor of CSU and depression. METHODS: Thirty patients with CSU, 30 patients with depression, 30 patients with both CSU and depression and 30 healthy volunteers as control group were involved in the study. Serum 25-hydroxyvitamin D (25(OH) D) levels of these groups were measured and compared. Correlations between 25(OH)D levels and the activity of CSU and depression were analyzed. RESULTS: Healthy controls' 25(OH)D levels (17.2 ± 8.8 ng/mL) were higher than patients with CSU (9.1 ± 5.1 ng/mL), depression (8.9 ± 6.1 ng/mL) and CSU with depression (7.7 ± 4.7 ng/mL) (p < 0.001, p < 0.001 and p<0.001, respectively). There were no differences in 25(OH)D levels between CSU patients with and without depression, between depression patients and CSU patients with and without depression (p = 0.43, p = 0.82 and p=0.92, respectively). There were no correlations between 25(OH)D levels and the activity of CSU or depression (p=0.99 and p = 0.76, respectively). CONCLUSION: Lower 25(OH)D levels in CSU and/or depression may appear as a secondary phenomenon, which means being result of these diseases rather than the cause (Tab. 1, Fig. 2, Ref. 41).

Psoriasis is a chronic, inflammatory, and systemic disease. The disease activity is usually measured by Psoriasis Area and Severity Index (PASI), however, further objective laboratory tools are needed. Neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and mean platelet volume (MPV) are objectively calculated markers that increase in inflammation. This study aimed to investigate the utility of these markers for follow-up of systemic inflammation and response to treatment. Material and methods: A total of 25 patients who had moderate or severe psoriasis vulgaris, who received ustekinumab treatment were retrospectively evaluated in the study. In patients, pre-treatment PASI, complete blood count parameters, serum CRP levels and NLR, PLR and MPV values in the follow up when they achieved PASI 75 and/or more improvement were recorded. Patients with an additional inflammatory disease or accompanying infection were excluded from the study. Results: While a statistically significant decline was recorded in NLR and PLR (p<0.05), no significant change was observed in MPV and CRP after the therapy success where patients achieved an improvement greater than or equal to PASI 75. Conclusion:We conclude that the correlation with the response to treatment and NLR and PLR levels show that these markers may be beneficial for assessment of disease severity either in combination with current scores or alone. These markers are cost effective predictors that can easily be measured in routine practice.