eMedicine Specialties > Dermatology > Allergy & Immunology
Urticaria, Dermographism: Treatment & Medication
Updated: Feb 26, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Patients with simple dermographism are asymptomatic and require no therapy.
Recognition of the problem, avoidance of precipitating physical stimuli, reduction of stress and anxiety are important factors in medical care. Also, scratching because of dry skin can be reduced with good skin care and emollients.
H1 antihistamines are the drugs of choice. In some patients, several antihistamines or a combination of two may be required. Sedating antihistamines such as hydroxyzine can be helpful. Regular treatment may need to be continued for several months.
The addition of H2-receptor antagonists appears to result in little symptomatic benefit, although some studies have shown a further small reduction in the whealing response.10
Physical urticarias are usually unresponsive to systemic corticosteroids.
Narrowband UV-B phototherapy and oral psoralen plus UV-A light therapy have both been used as treatments for symptomatic dermographism. Subjective relief of pruritus and whealing and objective reduction of wheals are apparent.11 However, improvement is short-lived, and most patients relapse within 2-3 months of completing phototherapy.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antihistamines
Act by competitive inhibition of histamine at the H1 receptor, H2 receptor, or both. This mediates wheal and flare reactions, bronchial constriction, mucus secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.
Cetirizine (Zyrtec, Zyrtec Chewable Tablets)
Forms complex with histamine for H1-receptor sites in blood vessels, GI tract, and respiratory tract.
Adult
10 mg PO qd
Pediatric
<2 years: Not recommended
2-6 years: 5 mg PO qd or 2.5 mg PO bid
>6 years: Administer as in adults
Increases toxicity of CNS depressants
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Sedation and antimuscarinic effects (low); caution in hepatic or renal dysfunction; doses >10 mg/d may cause drowsiness
Loratadine (Claritin)
Selectively inhibits peripheral histamine H1 receptors.
Adult
10 mg PO qd
Pediatric
<2 years: Not recommended
2-12 years and <30 kg: 5 mg PO qd
>30 kg: Administer as in adults
Ketoconazole, erythromycin, procarbazine, and alcohol may increase levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Initiate therapy at lower dose in liver impairment
Desloratadine (Clarinex)
Long-acting tricyclic histamine antagonist selective for H1 receptor. Relieves nasal congestion and systemic effects of seasonal allergy. Major metabolite of loratadine, which, after ingestion, is metabolized extensively to active metabolite 3-hydroxydesloratadine.
Adult
5 mg PO qd
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Data are limited; erythromycin and ketoconazole increase desloratadine and 3-hydroxydesloratadine plasma concentrations, but no increase in clinically relevant adverse effects, including QTc, observed
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Decrease dose in hepatic impairment; rarely causes pharyngitis or dry mouth
Acrivastine (Semprex)
Competes with histamine for H1 receptors on GI tract, blood vessels, and respiratory tract, reducing hypersensitivity reactions.
Adult
8 mg PO tid
Pediatric
Not established
Guanethidine, methyldopa, reserpine, or beta-blockers may decrease effects; CNS depressants, alcohol, and sympathomimetics increase toxicity
Documented hypersensitivity; within 14 d of initiating MAOI therapy; severe coronary disease; severe hypertension; elderly
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Sedation and antimuscarinic effects may occur; caution in high blood pressure, diabetes, ischemic heart disease, GI or GU obstruction, thyroid disease, prostatic hypertrophy, and increased intraocular pressure
Fexofenadine (Allegra)
Competes with histamine for H1 receptors on GI tract, blood vessels, and respiratory tract, reducing hypersensitivity reactions. Does not sedate.
Adult
60 mg PO bid
Pediatric
<12 years: Not recommended
>12 years: Administer as in adults
Toxicity increases with coadministration of erythromycin and ketoconazole
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
No data available on use while breastfeeding; may cause dizziness
Hydroxyzine (Atarax, Vistaril, Vistazine)
Sedative antihistamine that is also anxiolytic. Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS.
Adult
Pruritus: 25 mg PO hs initially; increase prn to 25 mg PO tid/qid
Anxiety: 50-100 mg PO qid
Pediatric
<6 months: Not recommended
6 months to 6 years: 5-15 mg/d PO; increase to 50 mg/d PO divided tid/qid
>6 years: 15-25 mg/d PO; increase to 50-100 mg/d PO divided tid/qid
May enhance response to alcohol, barbiturates, and other CNS depressants
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Associated with clinical exacerbations of porphyria (may not be safe for porphyria patients); ECG abnormalities (alterations in T waves) may occur; may cause drowsiness
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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Further Reading
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
