Background: Chronic urticaria severely affects quality of life. To date, no gold standard has been established to measure the burden of suffering, which often correlates poorly with the skin symptoms observed in patients with chronic urticaria.

Objective: To investigate the effect of psychological factors on the course of urticaria.

Methods: Health-related quality of life was assessed in 95 patients with chronic urticaria using the following instruments: Pictorial Representation of Illness and Self Measure (PRISM), Dermatology Life Quality Index (DLQI), and Skindex-29. Correlations were calculated. Cognitive flexibility and its correlation with the course of urticaria were assessed. Two case reports are presented to further elucidate
features of PRISM.

Results: PRISM revealed a high burden of suffering that was consistent with considerably impaired quality of life as measured by DLQI and Skindex-29 in the same patients. However, no significant correlation was observed between PRISM and the 2 quality of life questionnaires. From the baseline visit to the follow-up visit, quality of life scores improved significantly (DLQI, P=.001; Skindex-29, P=.001), whereas the PRISM score remained unchanged (P=.085). Disease course was favorable more often in cognitively flexible patients (n=54) (91%) than cognitively inflexible patients (P=.007).

Conclusions: PRISM revealed a high burden of suffering in chronic urticaria and provided helpful additional information for the management
of these patients. In our cohort, cognitive flexibility was a positive predictive marker for the course of chronic urticaria.

Key words: DLQI. PRISM. Quality of life. Skindex-29. Urticaria.