An urticarial eruption brought on by pressure or stress to the skin is known as dermatographia, often referred to as dermographism urticaria or urticaria factitia. There are several reasons for urticarial skin responses, which manifest as erythematous wheals in the dermis. The most prevalent form of inducible/physical urticaria, which affects 2% to 5% of the population, is dermatographism.

Dermatographism, which translates to "writing on the skin," is a condition in which downward pressure on the skin results in linear erythematous wheals in the dermis that are shaped like the external force being applied. A tiny percentage of patients with dermatographism have pruritus, stinging, or prickling symptoms, which can be uncomfortable for the sufferer.

Dermatographia: Causes

There is no known etiology for dermatographia. Although no specific allergen has been identified, it might be an allergic response.

Dermatographia symptoms might be brought on by simple causes. Your skin may get irritated by, for instance, friction from your clothes or bedsheets. In some people, an illness, mental stress, vibration, exposure to the cold, or taking medication comes before the symptoms.

Dermographism’s precise etiology is unclear. Histamine release from mast cells is considered to be involved, however. People with diabetes, hyperthyroidism, hypothyroidism, menopause, pregnancy, or medication-related dermatographism have been seen.

Dermatographism has no final mechanism that explains why it happens.

  • Vasoactive mediators are activated by mechanical stress as a result of antigen-bound IgE interaction with mast cells. The "triple response of Lewis" is a biological reaction that is considered to be triggered as a result of this.

  • In the beginning, the capillaries dilate, resulting in an erythematous phase that is only superficial. After arteriolar dilatation, an axon-reflex flare and transmission to sensory nerve fibers result in an extension of erythema. The linear wheal is lastly created by fluid transudation. After receiving an external stimulation like stroking of the skin, this full reaction can take up to 5 minutes on average.

  • The Lewis triple reaction typically decreases within 10 minutes, although the wheel can last anywhere from 15 to 30 minutes. A part in this process is thought to be played by mediators such histamine, leukotrienes, bradykinin, heparin, kallikrein, and peptides like substance P. Symptomatic dermatographism is often believed to be idiopathic, however, there are other possibilities.

  • The most widespread agreement centers on bites, scabies, medications like penicillin, and Helicobacter pylori as the more frequent presentations to support this association. Last but not least, the presenting symptom of systemic mastocytosis is congenital symptomatic dermatographism.

Dermatographia: Symptoms

When mechanical injury to the skin, most frequently from stroking, dermatographism lesions develop. In between five and ten minutes, a wheal begins to form and grow. Around 15 to 30 minutes will pass as the wheal continues. The wheal will get bigger further edema extends into the dermis.

The wheal of symptomatic dermatographism is accompanied by itching. The pruritus is worse at night (perhaps because of the friction caused by the sheets and bedding pressing on the skin) and from external stimuli such as heat, stress, emotion, and exercise.

The trunk, extremities, and other body surfaces are those that dermatographism most frequently affects. The scalp and vaginal region are the least often reported locations, however symptomatic dermatographism has been linked in the literature to dyspareunia and vulvodynia.

Dermatographism has various uncommon subtypes, including −

  • Dermatographism in red (small punctate wheals, predominantly on the trunk)

  • Dermatographism with follicles (isolated urticarial papules)

  • Dermatographism involving choline (similar to cholinergic urticaria – large erythematous line marked by punctate wheals)

  • Dermatographism in delay (tender urticarial lesion reappears 3 to 8 hours after the initial injury that persists up to 48 hours)

  • Cold-precipitated

  • Exercise-induced

  • Familial

Dermatographia: Risk Factors

At any age, dermatographia can develop. Teenagers and young adults seem to experience it more frequently. You might be more vulnerable if you have other skin issues. Atopic dermatitis is one of them (eczema).

Dermatographia: Diagnosis

The diagnosis of dermatographia is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

Your doctor may use a tongue depressor to make lines on the skin of your arm or back to see if you have dermatographia. You most likely have the disease if a raised line or welt develops within a short period.

Dermatographia: Treatment

Controlling dermatographism requires preventing and avoiding triggering causes like physical stimulation and reducing stresses. The majority of people are asymptomatic, thus only those with symptoms should receive treatment. Treatment with H1 antihistamines like cetirizine or loratadine is a form of choice therapy. If H1 blockers are insufficient to manage pruritus, H2 antihistamines can be coupled for a more comprehensive course of treatment. One approach is to take the sedative antihistamine hydroxyzine before bed.

Dermatographism research studies are looking at omalizumab, which has a 72% efficacy on 150 mg and a 58% efficacy on 300 mg. Interestingly, there was a statistically significant improvement in the patients' Dermatology Life Quality Index (DLQI) score of at least 4 points. Dermatographism has been somewhat successfully treated with light therapy, although most patients return within 2 to 3 months of finishing treatment.

Supplemental therapy with 1000 mg of over-the-counter vitamin C per day is suggested to lessen Lewis' triple reaction by assisting in histamine degradation and increasing elimination.

Dermatographia: Prevention

Some of the measures that can help to prevent dermatographia include −

  • Be gentle with the skin. Use a non-soap cleanser or light soap, then pat the skin dry. Wear items made of scratch-free fabric. While taking a shower or bath, use warm water.

  • Avoid rubbing your skin. Don't scratch, please. This advice is useful for all skin issues.

  • Keep your skin hydrated. Employ ointments, creams, or lotions every day. Lotions don't often work as well as creams and ointments do since they are thinner. When your skin is still moist after showering, apply your skin care product. When required, use it once more during the day.


Dermographism’s painstaking progression without resolve can be disconcerting. Nonetheless, patients need to be informed that the disease is benign. It is important to warn the patient not to take the medicine before driving a vehicle because the therapy, antihistamines, might cause drowsiness.

The majority of patients and their parents find dermatologic lesions to be benign yet surprising. To prevent these stresses, it is crucial to appropriately inform the patient and their parents about the risk factors linked to the development of dermatographism. When unsure about the diagnosis, consult a dermatologist.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 18-Apr-2023


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