Dermographism Urticaria Treatment & Management

Updated: Mar 29, 2016
  • Author: Simone Laube, MD, MRCP; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Approach Considerations

Dermographism can be distressing but is not life threatening. Patients with simple dermographism are asymptomatic and require no therapy. Patients with symptomatic dermographism should be treated until the problem is adequately controlled or resolved.

Recognition of the problem, avoidance of precipitating physical stimuli, reduction of stress and anxiety are important factors in medical care. In addition, scratching because of dry skin can be reduced through good skin care and the use of emollients.

Pharmacologic therapy

H1 antihistamines are the drugs of choice. In some patients, a combination of 2 or more antihistamines may be required. Sedating antihistamines such as hydroxyzine can be helpful. Regular treatment may have to be continued for several months. In a self-reported questionnaire of patients taking H1 antihistamines,18 (23%) of 79 were completely free from symptoms, 39 (49%) of 79 had a marked improvement, and only 3 (4%) of 79) reported no effect. [14] 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. [15] Physical urticarias are usually unresponsive to systemic corticosteroids.

Omalizumab, a recombinant humanized monoclonal antibody against immunoglobulin E (IgE), has been successfully used in patients with physical urticaria, including symptomatic dermographism. It is administered subcutaneously at an initial dosage of 150 mg/mo, but the dosage can be increased to 300 mg/mo. Some patients have reported complete symptom resolution within days after the first injection. [16] Omalizumab was successfully used in a woman with 3 subtypes of chronic urticaria, including symptomatic dermographism. [17] Treatment was continued throughout the patient's pregnancy without any complications or obvious adverse effects, although the frequency of injections had to be increased to every 15 days.

Reinitiation of omalizumab treatment after relapse of disease appears to result in rapid and complete symptom control again after the first injection within the first 4 weeks, and no relevant adverse effects have been reported. [18]

Light therapy

Narrowband ultraviolet (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 have been reported. [19] However, the improvement is short-lived, and most patients relapse within 2-3 months of completing phototherapy.