Dermographism Urticaria 

  • Author: Simone Laube, MD, MRCP; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 5, 2011
 

Background

The term dermographism literally means writing on the skin. Firm stroking of the skin produces an initial red line (capillary dilatation), followed by an axon-reflex flare with broadening erythema (arteriolar dilatation) and the formation of a linear wheal (transudation of fluid/edema) termed the triple response of Lewis. An exaggerated response to this constitutional whealing tendency is seen in approximately 2-5% of the population and is termed dermographism. In a minority of people, it is accompanied by itching (symptomatic dermographism).

For information on other the types of urticaria not discussed in this article, see the following articles:

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Pathophysiology

The exact mechanism of dermographism remains uncertain. Trauma may release an antigen that interacts with the membrane-bound immunoglobulin E of mast cells, which release inflammatory mediators, particularly histamine, into the tissues. This causes small blood vessels to leak, allowing fluid to accumulate in the skin. Other mediators possibly involved are leukotrienes, heparin, bradykinin, kallikrein, and peptides such as substance P.

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Epidemiology

Frequency

International

Dermographism is the most common of the physical urticarias and can occur with other forms of urticaria. Increased incidence has been reported in pregnancy (especially in second half), at the onset of menopause, in atopic children, and in patients with Behçet disease.[1]

Mortality/Morbidity

Simple dermographism is the most common variant, and patients with this form are asymptomatic. However, other forms are associated with pruritus, and this can significantly affect people's quality of life. Most people with dermographism are otherwise healthy. An association with thyroid disease has been described in some patients but remains controversial.

Race

No racial variance in prevalence is known.

Sex

Whether a sexual variance in prevalence occurs is unclear. None has been consistently reported, although one study on dermographism in children reported a female predominance.[2]

Age

Dermographism can appear in persons of any age but is more common in young adults. Peak incidence is in the second and third decades.

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Contributor Information and Disclosures
Author

Simone Laube, MD, MRCP  Consulting Staff, Department of Dermatology, Borders General Hospital, Melrose and Western General Hospital

Simone Laube, MD, MRCP is a member of the following medical societies: British Association of Dermatologists

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Elsbeth Young, MD, FRCP, to the development and writing of this article.

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].

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