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Dermographism: I scratch, therefore I hive!

Dermographism literally means “skin writing.”  While firm stroking of the skin usually leaves some redness and occasionally mild raised areas, about 5% of normal young people have a conspicuous and exaggerated response called simple dermographism.  There is no associated itching and this is in the range of normal and does not require treatment.

Immediate symptomatic dermographism also known as “factitious urticaria” occurs when mild stroking of the skin or mechanical irritation is accompanied by itching, redness and raised usually linear wheals (hives in streaks) of the skin peaking at 5 to 10 minutes and subsiding at 30 to 60 minutes.  The itching is worse with alcohol, heat and stress.  Symptoms are often most severe at night.  These hives occur at areas of friction including neck (shirt collar) and cuff lines, as well as scalp, palms, soles and genital area.  It does not affect the tongue, throat, lungs or esophagus and there is no associated swelling (angioedema).

How common is this?  Reports vary, but it seems to be about 4.2% of the general population.  This is the most common type of “physical” urticaria (hives). Other “physical” causes of hives are cold, heat, sunlight, vibration, water, and pressure.  There is only 1 case where numerous family members had dermographism suggesting nearly all cases are not genetic but idiopathic (we don’t know!).  Also 1 case of affected identical twins was reported.

What causes dermographism?  It’s believed to be an allergic reaction mediated by the allergic antibody IgE and less commonly IgM. During the mechanical stroking of the skin, an IgE antibody is formed against an antigen released by mild skin trauma. The IgE cross links on mast cells and releases histamine which is responsible for the hives and itching.  It is not related to food or environmental allergy, autoimmune or other diseases.  It has occurred in patients who were treated with penicillin, famotidine, or who had scabies or trauma from a coral reef.

Are there other kinds of dermographism?  Yes.  There are subtypes including:

  • Localized: these occur at the site of tattoos or other skin conditions
  • Red: occurs after repeated rubbing rather than a simple single stroke
  • White: after light stroking of the skin, there is vasoconstriction, leading to white (not red) streaks
  • Black:  discoloration of the skin after pressure from a metallic object
  • Cholinergic:  this is seen in some patients with chronic hives where the hives from rubbing are tiny
  • Pure delayed: after fading, the linear hives return at the same site and are tender lasting for up to 2 days.

Who is affected and how long does it last?  While dermographism can occur at any age, 29% of patients are less than 19 years old.  Dermographism may last for months or even years.  The average course was 20 months in 1 study and 5 years in another study.  It can be present intermittently and persist for over 10 years.

Can dermographism be treated?  Yes.  At Family Allergy & Asthma Care of Montana, we provide an individualized treatment plan to provide relief of symptoms.

This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional. 

  1. Brian McMahonBrian McMahon12-29-2014

    Hi

    My dermographism started when I was 21 I am now 32 and there are no signs of it improving.

    Brian

  2. AnnaMAnnaM08-08-2016

    I had this problem for long time …i tried everything and nothing worked untill I give up gluten.
    After one month of going gluten free my skin was glowing ànd no sign of dermographism.
    Now Is been 7 months of gluten free and never felt better.

    • Jim BiondolilloJim Biondolillo03-19-2017

      My experience is identical. I developed dermographism in my mid thirties and suffered for the better part of 20 years. My wife was diagnosed with Celiac disease 2 years ago so we both quit eating any food containing gluten. After about 2 months my symptoms completely disappeared and I have had no recurrence.

  3. alan spenceralan spencer09-06-2016

    20 months. Mine started at 22 and I’m now 34. My itching is terrible if I don’t take zyrtec

  4. LilyLily04-27-2017

    I’ve been suffering from dermatographism for more then 17 years. I stopped taking my antihistamines a few weeks ago and now I have terrible itchy skin. It’s so depressing to live with the embarrassing red marks on my face and all over my body. Is there any medication or treatment that will help me to get rid of this problem?

  5. Dana DishonDana Dishon06-07-2017

    I was diagnosed 12 years ago, every medication I have tried worked for a short while and then my body grew immune to it. I’ve tried Doxophine, Aterax, Zyrtec, Cimetidine, and many more. I’ve tried cutting out sugar, gluten and pretty much everything else I could try. Today was one of the worst days, my right eye lid had hives inside and out, my right ear and my entire neck. I don’t know what else to do at this point. I’m miserable in my own skin.

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