eMedicine Specialties > Dermatology > Allergy & Immunology

Urticaria, Dermographism: Differential Diagnoses & Workup

Author: Simone Laube, MD, MRCP, Consulting Staff, Department of Dermatology, Aberdeen Royal Infirmary, UK
Contributor Information and Disclosures

Updated: Feb 26, 2009

Differential Diagnoses

Mastocytosis
Urticaria, Chronic

Other Problems to Be Considered

Systemic mastocytosis and urticaria pigmentosa are associated with a positive Darier sign.

Forms of false dermographism (misnomers, not associated with urticaria) include (1) white dermographism, which is a blanching response resulting from capillary vasoconstriction following skin stroking and is more pronounced in persons with atopy; (2) black dermographism, which is black or greenish discoloration of the skin after contact with certain metallic objects; and (3) yellow dermographism, which probably results from bile pigment deposits in the skin.

Workup

Laboratory Studies

  • The results from hematological and biochemical screening tests are normal. In some patients, an increase in blood histamine levels is seen after experimental scratching.

Procedures

  • The diagnosis is usually made by observing the clinical response after using moderate pressure to stroke or gently scratch the skin. The site is important because areas protected from regular pressure and environmental influences, such as the back, are more reactive than more exposed areas, such as the buttocks and limbs.
  • A dermographometer (spring-loaded stylus) can be used to apply graded, reproducible pressure (eg, 3600 g/cm2) and record skin responses. It is mostly limited to research settings.

Histologic Findings

  • Biopsy specimens show dermal edema with a few perivascular mononuclear cells.

More on Urticaria, Dermographism

Overview: Urticaria, Dermographism
Differential Diagnoses & Workup: Urticaria, Dermographism
Treatment & Medication: Urticaria, Dermographism
Follow-up: Urticaria, Dermographism
References
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References

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  2. Martorell A, Sanz J, Ortiz M, Julve N, Cerda JC, Ferriols E. Prevalence of dermographism in children. J Investig Allergol Clin Immunol. May-Jun 2000;10(3):166-9. [Medline].

  3. Lambiris A, Greaves MW. Dyspareunia and vulvodynia: unrecognised manifestations of symptomatic dermographism. Lancet. Jan 4 1997;349(9044):28. [Medline].

  4. Matthews CN, Warin RP. Cold urticaria and cold precipitated dermographism. Br J Dermatol. Jan 1970;82:91. [Medline].

  5. Jedele KB, Michels VV. Familial dermographism. Am J Med Genet. May 1 1991;39(2):201-3. [Medline].

  6. Grimm V, Mempel M, Ring J, Abeck D. Congenital symptomatic dermographism as the first symptom of mastocytosis. Br J Dermatol. Nov 2000;143(5):1109. [Medline].

  7. Taskapan O, Harmanyeri Y. Evaluation of patients with symptomatic dermographism. J Eur Acad Dermatol Venereol. Jan 2006;20(1):58-62. [Medline].

  8. Wallengren J, Isaksson A. Urticarial Dermographism: Clinical features and response to psychosocial stress. Acta Derm Venereol. 2007;87:493-8. [Medline].

  9. Wu JJ, Huang DB, Murase JE, Weinstein GD. Dermographism secondary to trauma from a coral reef. J Eur Acad Dermatol Venereol. Nov 2006;20:1337-8. [Medline].

  10. Sharpe GR, Shuster S. In dermographic urticaria H2 receptor antagonists have a small but therapeutically irrelevant additional effect compared with H1 antagonists alone. Br J Dermatol. Nov 1993;129(5):575-9. [Medline].

  11. Borzova E, Rutherford A, Konstantinou GN, Leslie KS, Grattan CE. Narrowband ultraviolet B phototherapy is beneficial in antihistamine-resistant symptomatic dermographism: A pilot study. J Am Acad Dermatol. Sept 2008;59:752-7. [Medline].

  12. van der Valk PG, Moret G, Kiemeney LA. The natural history of chronic urticaria and angioedema in patients visiting a tertiary referral centre. Br J Dermatol. Jan 2002;146(1):110-3. [Medline].

  13. Casale TB, Sampson HA, Hanifin J, et al. Guide to physical urticarias. J Allergy Clin Immunol. Nov 1988;82(5 Pt 1):758-63. [Medline].

  14. Champion RH. Urticaria: then and now. Br J Dermatol. Oct 1988;119(4):427-36. [Medline].

  15. Giam YC, Rajan VS. An approach to urticaria. Ann Acad Med Singapore. Jan 1983;12(1):74-80. [Medline].

  16. Grattan CEH, Kobza Black A. Urticaria and mastocytosis. In: Burns DA, Breathnach SM, Cox N, Griffiths C, eds. Rook's Textbook of Dermatology. Vol 3. 7th ed. London, England: Blackwell Science; 2004:47.1-47.37.

  17. Jorizzo JL, Smith EB. The physical urticarias. An update and review. Arch Dermatol. Mar 1982;118(3):194-201. [Medline].

  18. Kirby JD, Matthews CN, James J, Duncan EH, Warin RP. The incidence and other aspects of factitious wealing (dermographism). Br J Dermatol. Oct 1971;85(4):331-5. [Medline].

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Further Reading

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Keywords

dermatographism, urticaria, urticarial dermographism, factitious urticaria, allergy, allergic reaction, anaphylaxis, anaphylactoid reaction, angioedema, triple response of Lewis, linear wheal, whealing, red dermatographism, red urticaria, skin scratch reactions, hives, itching

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Contributor Information and Disclosures

Author

Simone Laube, MD, MRCP, Consulting Staff, Department of Dermatology, Aberdeen Royal Infirmary, UK
Simone Laube, MD, MRCP is a member of the following medical societies: British Association of Dermatologists
Disclosure: Nothing to disclose.

Medical Editor

Shyam Verma, MBBS, DVD, FAAD, Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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