Core Dermatology Diagnoses / CategoriesInflammatory

Dermatographism

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Publish date: Posted on
Last updated: May 19, 2022

Keywords #

dermatographism
dermatographia
dermatographic urticaria
physical urticaria

Diagnosis #

Dermatographism manifests as an urticarial eruption resulting from direct pressure or trauma to the skin. It is the most common form of physical or inducible urticaria and can be an incidental finding related to associated dermatologic conditions, such as atopic dermatitis. Dermatographism is usually idiopathic in its etiology, but can be triggered by infections or exposure to penicillin.[1,2}

Key Concepts #
  • Dermatographism means “to write on the skin.”
  • Although its etiology is unknown, dermatographism is thought to be due to the release of histamine from mast cells.
  • Dermatographism is benign condition, sometimes asymptomatic.
  • Dermatographism is the most common form of physical urticaria.
Epidemiology #

It affects 2-5% of the population and most commonly occurs in young adults.

Clinical Features #
  • Dermatographism presents as an urticarial wheal reaction induced by pressure. It is most easily elicited by running a wooden stick or tongue depressor along the skin of the upper back or forearms.
  • A few variants of dermatographism can present as punctate wheals or urticarial papules across the trunk and extremities.
Differential Diagnoses #
Diagnostic Workup #

A wheal is induced by stroking the skin with a firm object, such as a pen or tongue depressor.[3] The wheal appears after about 5minutes and begins to fade within 15-30 minutes, confirming the clinical diagnosis.[3]

Treatment #

Asymptomatic dermatographism requires no therapy, and it is recommended to avoid any physical stimuli or associated triggers. Symptmatic dermatographism can be treated with first and second-generation H1 antihistamines, including hydroxyzine or cetirizine, to reduce wheal formation and improve pruritus.[5,6] The addition of an H2 antihistamine does not demonstrate a clear synergistic effect, but can be trialed for symptomatic relief.[7] Refractory dermatographism may also respond to narrowband UVB phototherapy.

References #
  1. Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000;105(4): 664.
  2. Smith JA, Mansfield LE, FokakisA, Nelson HS. Dermographia caused by IgE medicated penicillin allergy. Ann Allergy. 1983;51(1 Pt 1): 30.
  3. Kirby JD, Matthews CN, James J, Duncan EH, Warin RP. The incidence and other aspects of factitious wealing (dermographism). Br J Dermatol.1971;85(4):331-335.
  4. Orfan NA, Kolski GB. Physical urticarias. Ann Allergy. 1993;71(3): 205.
  5. Warin RP. Factitious urticaria: red dermographism. Br J Dermatol. 1981;104(3): 285.
  6. Deutsch PH. Dermatographism treated with hydroxyzine and cimetidine and ranitidine. Ann Intern Med. 1984;101(4): 569.
  7. Garafalo J, Kaplan AP. Histamine release and therapy of severe dermatographism.J Allergy Clin Immunol. 1981;68(2): 103.
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