What is dermatographia?
Dermatographia, also known as dermographism urticaria, is a benign skin condition with superficial redness and wheals. Most people are asymptomatic, but some may have accompanying symptoms such as itching (pruritus), stinging, and prickling sensation.
Dermatographia is the development of red, swollen lines or welts, called wheals, on the skin that occurs with pressure, firm stroking, or light scratching. The term dermatographism or dermographism literally means writing on the skin. Red wheals form in the shape of the pressure applied on the skin.
Wheals usually develop within five minutes after scratching and go away on their own within 30 minutes. Delayed type of dermatographia may last from several hours to days. In most people, dermatographia forms lines of welts with redness around them.
Less common types of dermatographia include:
- Red dermographism: Small wheals with tiny dots or holes (punctate wheals) in them, mostly on the torso
- Follicular dermographism: Small isolated bumps around hair follicles with redness around
- Cholinergic dermotographism: Large red lines studded with punctate wheals, with capillary bursting (purpura) in severe cases
- Delayed dermographism: Return of wheals three to eight hours after the initial response, which may last up to 48 hours
- Familial dermographism: An extremely rare inherited condition
- Cold-precipitated dermographism: Only one known case
- Exercise-induced dermographism: Stimulated by exercise
What are the symptoms of dermatographia?
Dermatographia, also known as dermographism urticaria, is a benign skin condition with superficial redness and wheals. Most people are asymptomatic, but some may have accompanying symptoms such as:
- Itching (pruritus)
- Stinging
- Prickling sensation
Dermatographia usually occurs in the torso, extremities, and other body surfaces, and is uncommon in the scalp and genital region. Symptomatic dermographism, however, has been reported to be linked to pain in the vulva (vulvodynia) and pain in the genital area (dyspareunia) during sexual intercourse, in rare cases.
What causes dermatographism?
The exact cause of dermatographia is unclear. The response to pressure on the skin is called Lewis's triple response, caused by immune reaction and release of antibodies known as immunoglobulin E (IgE). Mast cells, a type of immune cell, react to IgE and release inflammatory compounds such as histamine and leukotrienes into the tissue leading to a set of three reactions:
- Tiny blood vessels (capillaries) dilate forming red lines
- Nerve endings respond causing redness of the skin
- Capillaries leak fluid into the skin tissue forming raised wheals
The mast cell response is exaggerated in individuals with dermatographia. Symptomatic dermatographia often seems to occur for no apparent reason but may involve a degree of autoimmune response. Dermatographia may be triggered by:
- Medications such as penicillin
- Insect bites
- Helicobacter pylori infection
- Parasitic infestation such as scabies
- Stressful events
- Tight clothing, or rubbing against bed linen can often aggravate symptoms at night
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Who gets dermatographia?
Dermatographia occurs in approximately 2% to 5% of the general population. Dermatographia can occur at any age but is more common in young adults in their 20s and 30s. Dermatographia incidence has been reported to be higher in the following situations:
- During pregnancy, especially the second half
- At the onset of menopause
- In children with a genetic tendency to develop allergies (atopy)
- In people with Behcet’s disease, a disorder that causes blood vessel inflammation, and oral and genital ulcers
- Diabetes patients
- Approximately 75% of people with the hypereosinophilic syndrome, a condition with persistently high eosinophil count without a known cause
- People with hypothyroidism or hyperthyroidism
How do you get rid of dermatographia?
Asymptomatic dermatographia requires no therapy, but symptomatic dermatographia may require treatment because it can be distressing and significantly impact the quality of life. Treatments include:
Light therapy
Ultraviolet light therapy has been used to treat symptoms of dermatographia but has not been found to be effective for the long-term, because symptoms returned within a couple of months after completion of therapy.
Medications
Medications used to treat dermatographia include the following:
- Antihistamines: Antihistamines block histamine activity to prevent dermatographic flare of wheals. Antihistamines include:
- Cetirizine hydrochloride (Zyrtec)
- Loratadine (Claritin)
- Desloratadine (Clarinex)
- Levocetirizine dihydrochloride (Xyzal)
- Fexofenadine hydrochloride (Allegra)
- Hydroxyzine pamoate (Vistaril)
- Diphenhydramine
- Monoclonal antibodies: Lab-produced human antibodies which attach to immunoglobulin E and prevent the mast cells from releasing inflammatory substances. The monoclonal antibody used to treat dermatographia is:
- Vitamin C: Over-the-counter vitamin C tablets might be a helpful adjunct treatment. Vitamin C is thought to help degrade and remove histamines from the body.
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Is dermatographia permanent?
Most people with dermatographia are asymptomatic and otherwise healthy. The natural course of dermatographia is unpredictable and may last for months or years, or occur intermittently. In many people, dermatographia improves over the years and clears on its own or with treatment.
Approximately 36% of symptomatic dermatographia clears in five years and 51% in 10 years.
How do you prevent dermatographia?
It may not be possible to entirely prevent dermatographia, but the severity of symptoms may be reduced by taking some of the following precautions:
- Use moisturizers to prevent the skin from getting dry, which can cause an urge to scratch.
- Avoid using harsh soaps and other products that may irritate the skin.
- Wear loose cotton clothes.
- Avoid wearing woolen clothes next to the skin, which can irritate.
- Try to reduce stress and anxiety.
- Try to avoid hot conditions and hydrate adequately.
- Avoid excessively hot baths.
- Pat dry gently after a shower instead of rubbing down.
- Minimize exposure to the sun and wear sunscreen.
- Include in your diet anti-inflammatory foods such as seafood, leafy green vegetables, whole grains, fruits, turmeric, garlic, and ginger.