For patients with chronic spontaneous urticaria (CSU), fewer hives don't always mean controlled disease. Persistent itch, breakthrough flares, and quality-of-life burden can remain despite H1-antihistamine treatment, signaling the need for reassessment.

In this interactive discussion, Daniel Butler, MD, and David Seiter, FNP, DCNP, explore how dermatology PAs and NPs can recognize uncontrolled CSU, navigate guideline-based treatment escalation, and consider emerging approaches such as BTK inhibition. They bring the discussion back to everyday practice, including documenting disease burden, setting realistic treatment expectations, and partnering with patients to define meaningful treatment goals.

The discussion will be followed by a live Q&A.

Faculty

Daniel Butler, MD
Assistant Dean of Student Affairs
University of Arizona College of Medicine
Director, Inflammatory and Aging Skin Research Program

David Seiter, FNP, DCNP
Epiphany Dermatology
Phoenix, AZ

Following this program, attendees should be better able to:

• Recognize signs of uncontrolled CSU in patients receiving H1-antihistamines, including persistent symptoms and quality-of-life burden.

• Assess and document disease activity, treatment response, and patient-reported burden to inform treatment decisions.

• Apply guideline-based treatment strategies to determine when ongoing symptoms warrant escalation to advanced targeted therapy.

• Evaluate emerging CSU treatment data, including BTK inhibition, with attention to efficacy, safety, and implications for patient counseling.

• Incorporate shared decision-making, individualized treatment goals, and realistic expectations into patient counseling and follow-up.