Background: Chronic urticaria is a spontaneous or idiopathic mast cell driven disease which affects patients’ well-being and quality of life. This study aimed to determine the prevalence of chronic spontaneous urticaria (CSU) in a public tertiary hospital, to determine patients’ quality of life (QoL) and factors associated with impaired QoL. Methods: A cross-sectional study was conducted at Dermatology Clinic, Hospital Putrajaya. Patients aged more than 18 years diagnosed with CSU were included. Patients with other chronic diseases that may affect QoL were excluded. Data was collected by face to face interview. QoL was assessed using Dermatology Quality of Life (DLQI) questionnaire. Urticaria severity was determined using Urticaria Activity Score (UAS-7). Results: A total of 88 patients aged 40±13.9 years participated with a male to female ratio of 1:3.4. Prevalence of CSU was 0.9%. Mean total DLQI score was 6.3±5.46, 27.3% of patients had no QOL effects, 18.2% had small effect, 36.4% moderate effect and 17% very large effect. Symptoms & feelings subdomain revealed the most severe impairment, followed by leisure and daily activities. Median UAS-7 was 6, 51.1% of patients had well-controlled disease. Higher disease activity was associated with a higher DLQI (p=0.02). Risk factors assessed did not show statistically significant effect on QoL. Conclusion CSU had moderate effect on the QoL of most patients. Symptoms and feelings, leisure and daily activities were predominantly affected. Disease activity was negatively associated with QoL impairment.

Bullous pemphigoid (BP) is a chronic and the most frequent immune-mediated subepidermal blistering disorder which mainly affects elderly individuals. The autoantibodies produced following T-cell dysregulation are directed against BP180 (BPAg2) and BP230 (BPAg1), hemidesmosomal proteins located in the basement membrane zone (BMZ) of the epidermis. BP may present with polymorphic dermatological features including non-bullous manifestations and blisters. Therefore, a wide range of differential diagnoses such as eczema, urticaria, pemphigus and the differentials for subepidermal blister with eosinophils such as epidermolysis bullosa acquisita (EBA) and bullous drug eruptions should be considered in such cases. The associations of solid organ internal malignancies and BP are quite rare and vary between studies. Here, we present a case of paraneoplastic bullous pemphigoid (PNBP) in a patient with underlying renal cell carcinoma who was initially diagnosed with worsening hand-foot syndrome (HFS) which has led to withdrawal of his oral chemotherapy treatment.