Dermographism Urticaria Treatment & Management

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

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.[11]

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.[12] However, improvement is short-lived, and most patients relapse within 2-3 months of completing phototherapy.

Recently, omalizumab, a recombinant humanized monoclonal antibody against IgE, has been successfully used in patients with physical urticaria, including symptomatic dermographism. Omalizumab is administered subcutaneously at an initial dose of 150 mg/mo, but the dose can be increased to 300 mg/mo. Some patients have reported complete symptom resolution within days after the first injection.[13]

Proceed to Medication
 
 
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].

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  10. Rahim KF, Dawe RS. Dermatomyositis presenting with symptomatic dermographism and raised troponin T: a case report. Journal of Medical Case Reports. July 2009;3:7319. [Medline]. [Full Text].

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  12. 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].

  13. Metz M, Altrichter S, Ardelean E, at al. Anti-Immunoglobulin E Treatment of Patients with Recalcitrant Physical Urticaria. Int Arch Allergy Immunol. 2011;154:177-180. [Medline].

  14. 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].

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

  18. 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.

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

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  22. Nettis E, Pannofino A, D'Aprile C, Ferrannini A, Tursi A. Clinical and aetiological aspects in urticaria and angio-oedema. Br J Dermatol. Mar 2003;148(3):501-6. [Medline].

  23. Wong RC, Fairley JA, Ellis CN. Dermographism: a review. J Am Acad Dermatol. Oct 1984;11(4 Pt 1):643-52. [Medline].

 
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