What is Dermatographic Urticaria or Skin Writing?

Dermatographic urticaria or Skin Writing is also known as Dermographism or Dermatographia. Dermatographic urticaria or Skin Writing is a type of skin disorder that affects 4-5% of the world population and is the most common type of urticaria. In this condition, the skin becomes inflamed or swollen when slapped, scratched, rubbed and stroked. People who are suffering from Dermatographic urticaria or Skin Writing tend to develop a weal when the skin is lightly scratched and may disappear within half an hour or so.

Dermatographic Urticaria or Skin Writing

The exact cause of Dermatographic urticaria or Skin Writing is unknown, but it can be triggered due to infection, penicillin medication or being emotionally upset as well. Most people do not seek medical help when the dermographism is observed. However, when the symptoms and signs of Dermatographic urticaria or Skin Writing cannot be neglected, the doctor may suggest necessary treatments as well. This may involve anti-allergic medications like diphenhydramine called Benadryl.

Dermatographic urticaria or Skin Writing can be categorized as a type of chronic hives known as physical urticaria. The condition gets this name because the hives are developed by a peculiar stimulus on the body. In case of this condition, the stimulus strokes the skin with a specific object. The person who is affected by Dermatographic urticaria or Skin Writing often suffers with it for several years and the symptoms eventually fade away.

What are the Causes of Dermatographic Urticaria or Skin Writing?

The cause of Dermatographic urticaria or Skin Writing is not precisely known, but it may be caused when a body responds to certain allergies. Nevertheless, the allergens have not yet been identified.

Tiny little things can activate the Dermatographic urticaria or Skin Writing symptoms. As the condition is preceded by emotional upset, medication and infection, it can also be caused due to skin allergies to outside agents like worm infestation and scabies.

Types of Dermatographic Urticaria or Skin Writing

Dermatographic urticaria or Skin Writing can be segregated into two major categories like symptomatic dermographism and simple dermographism. The symptomatic Dermatographic urticaria or Skin Writing may involve itching whereas simple Dermatographic urticaria or Skin Writing includes swelling and inflammation of the skin.

Risk Factors for Dermatographic Urticaria or Skin Writing

The occurrence of Dermatographic urticaria or Skin Writing may be associated with any age group but is commonly witnessed in young adults and teenagers. Apart from this, if you have various skin allergies like dermatitis, then you might be susceptible to dermographism. Any skin condition that compels you to scratch can increase the risk of occurrence of Dermatographic urticaria or Skin Writing.

  • Dermographism can affect any age group but is commonly seen in teenagers. The onset may be sudden but the disappearance of symptoms may be gradual.
  • Sufferers of Dermatographic urticaria or Skin Writing are generally healthy, but some patients may report with thyroid diseases.
  • Some medical experts have speculated an association of nervous factor with this condition. The development of weal due to prolonged itching or scratching may occur at specific intervals.
  • This can be related to perturbing situations or agitation as well.
  • The symptoms often take a grave turn when the surrounding temperatures are hot.
  • The weals or hives on the skin may start developing due to energetic kissing, a little pressure from chair seats, clothes as well as a variety of tools. It may also be caused by clapping of hands.
  • The hives may also develop post-exercise when there is too much pressure on the skin. Games like wrestling, rugby and boxing may cause such weal on the skin.
  • Wrapping the towel around the body after a warm bath may also assist in weal development.
  • Once a tiny weal has developed it can affect the skin in its vicinity due to subsequent scratching. Usually they are superficially developed, but giant weal may have deeper extension. The swelling develops, but is resides after half an hour or so.
  • Dermatographic urticaria or Skin Writing can also occur due to other kinds of urticaria and can also be caused due to cold or pressure on the skin.
  • Dermatographic urticaria or Skin Writing may last for a few months and can stay for a prolonged time as well. The symptoms may subside when the wealing is reduced to certain degrees and does not give rise to other symptoms.

Signs and Symptoms of Dermatographic Urticaria or Skin Writing

The symptoms and signs of Dermatographic urticaria or Skin Writing may begin appearing when the skin is scratched or rubbed and will subside within half an hour. In extreme cases, the symptoms develop gradually and last for days. The whole disease can last for months and years.

  • Inflammation
  • Hive-like welts
  • Raised red lines
  • Swelling
  • Itching.

Test to Diagnose Dermatographic Urticaria or Skin Writing

Initial diagnosis of Dermatographic urticaria or Skin Writing or dermographism may be done with a simple test. The doctor will use the tool for inspection across the skin of the exposed area to inspect whether it is red or swollen along with the occurrence of a weal within minutes after exposure.

Treatment for Dermatographic Urticaria or Skin Writing

Dermatographic urticaria or Skin Writing is not fatal, but it can be quite distressing. Patients who develop simple dermographism or Dermatographic urticaria or Skin Writing do not show significant symptoms and do not require therapy as well. However, the patients who show symptomatic dermographism should seek treatment in order to resolve or control the condition at an early stage.

Acknowledging the problem and prevention of physical stimuli as well as reduced levels of anxiety plus stress can be the important factors to consider in medical care. Emollients can be used for stopping the scratching of dry skin along with a proper medical care.

Pharmacologic Treatment for Dermatographic Urticaria or Skin Writing

H1 antihistamines can be included with one's choice. In some cases, a combination of several antihistamines may be used as well. Hydroxyzine, which is a sedating antihistamine, can prove to be helpful in treating the condition. Physical urticaria usually does not respond to systemic corticosteroids.

Omalizumab is a type of antibody that works against immunoglobulin E (IgE) and has been used in patients who are suffering from physical urticaria which includes symptomatic dermographism. In the initial stages, the dosage may be less, but it may be eventually increased with time. The entire symptom may be resolved within a few days after injection of the drug. This drug was used in women who showed some obvious symptoms of complications. However, with frequent injections the symptoms subsided and the frequency of doses was also increased to eliminate the problems permanently. Pharmacotherapy is used to reduce the occurrence of morbid symptoms and alleviate complications as well. Antihistamines form a basic part of the treatment for dermographism and can be included in pharmacologic therapy as well.

Second Generation Antihistamines:

  • Desloratadine
  • Cetirizine
  • Levocetirizine
  • Fexofenadine
  • Loratadine

First Generation Antihistamines:

  • Hydroxyzine
  • Diphenhydramine

Monoclonal Antibodies:

  • Omalizumab (Xolair)

Light Therapy For Dermatographic Urticaria or Skin Writing

Both the oral psoralen plus UV-A light therapy and Narrowband ultraviolet (UV) -B phototherapy can be used as a treatment for Dermatographic urticaria or Skin Writing that has associated symptoms. This may help in relieving wealing as well as pruritus and have shown significant results. Nevertheless, the advancement does not stay for a prolonged time and the patients may get back to the original state after completion of phototherapy.

Prevention of Dermatographic Urticaria or Skin Writing

Try the following things to bring down the symptoms and ease the discomfort associated with Dermatographic urticaria or Skin Writing:

  • Do not irritate your skin. Use of harsh soaps should be avoided. Refrain from wearing clothes made out of irritating materials like wool. Hot bath or showers may aggravate the symptoms of Dermatographic urticaria or Skin Writing.
  • Avoid scratching the skin. If you have Dermatographic urticaria or Skin Writing or dermographism, do not scratch the skin as it may worsen the condition and the weal may look more prominent.
  • Hydrate your skin by using moisturizers. Itching can be caused due to dry skin. Consume huge quantities of water to keep the moisture content in your skin intact and use quality lotions or skin creams.

Dermatographic Urticaria or Skin Writing in Babies and Children

Dermatographic urticaria or Skin Writing or Dermographism affects 1 in 20 individuals at some point in life. The chances of developing this disorder are in the early life and the condition will develop gradually and the severity may reduce after a few years. In some cases, it may stay longer and can be equally troublesome for prolonged years. If your toddler or kid shows signs of Dermatographic urticaria or Skin Writing or dermographism, you should contact the allergist instead of a pediatrician.

Lifestyle Changes for Dermatographic Urticaria or Skin Writing

  • Consume organic or fresh fruits in high quantities. Include a variety of vegetables, beans and nuts as well as stay away from processed or canned foods. Eating such canned foods may cause itching and anti-inflammatory foods can be the best choice at such times.
  • Increase the quantity of water consumption and avoid drinking soda or any other assorted drinks. This may dehydrate the skin and trigger itching as well. Ensure that the water you are drinking is filtered as tap water may be contaminated.
  • Use skin products that are designed for sensitive skin. Indulge in buying those lotions that are made using natural ingredients to keep your skin moisturized and hydrated. Coconut oil is by far the best and reliable source of moisturizing the skin. It smells good, is natural and helps in soothing the irritated skin as well.
  • If itching aggravates, use a cold compress or hold the area under running water. Never scratch the area over and over again as it may lead to its spreading in the vicinity.
  • Exercise regularly and rest equally. Do some drills on a jumping trampoline or yoga to pump up your heart rate. Stretch a little so that all your muscles have enough room for breathing.
  • Refrain from using artificial fragrances or perfumes as well as detergents. This may cause itching of your skin and make it worse.

Complications in Dermatographic Urticaria or Skin Writing

Dermatographic urticaria or Skin Writing is harmless and does not leave any spots or lasting marks after disappearance. They can only cause minor symptoms.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 25, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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