From the Guidelines
Dermatographism is primarily managed with antihistamines, which are effective in reducing the symptoms of this condition. The management of dermatographism involves the use of antihistamines as the first-line treatment. First-generation antihistamines like hydroxyzine (25-50mg three times daily) or second-generation options such as cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) are effective in treating dermatographism 1.
Treatment Approach
- Second-generation antihistamines are generally preferred as they cause less sedation compared to first-generation antihistamines.
- For severe cases, combining H1 antihistamines with H2 blockers like ranitidine (150mg twice daily) may provide additional relief.
- Treatment should be continued daily for several weeks, then patients can attempt gradual discontinuation to see if symptoms have resolved.
- Avoiding triggers is also important—these include hot showers, tight clothing, excessive scratching, and any identified specific irritants.
- Applying cool compresses and using fragrance-free moisturizers can help soothe affected skin.
Mechanism of Action
Antihistamines work by blocking histamine receptors, preventing the chemical mediator released during mast cell degranulation from causing the characteristic wheal and flare response when the skin is stroked or scratched. Although the provided evidence primarily focuses on atopic dermatitis, the principle of using antihistamines to manage symptoms related to mast cell degranulation can be applied to dermatographism as well 1. The most recent guideline from 2024 suggests considering alternative diagnoses and additional treatments if initial management is optimized but control is inadequate 1.
From the Research
Management of Dermographism
Dermographism is a common subtype of chronic urticaria that can be managed through various treatments. The goal of management is to alleviate symptoms and improve quality of life.
Treatment Options
- Avoiding triggers is the first step in managing dermographism 2
- Nonsedating H1 antihistamines are the first-line medications recommended by EAACI and other guidelines 2
- For those who do not respond to standard doses, the recommended dosage can be increased up to 4 times 2
- Off-label use of omalizumab can be considered when necessary 2
- Phototherapy, such as narrowband UVB phototherapy, has been used to treat symptomatic dermatographism 3, 4
- H1 and H2 antagonists, leukotriene antagonists, cyclosporine, and oral steroids are also treatment modalities for symptomatic dermatographism 3, 4
Evaluation and Assessment
- The Urticaria Control Test (UCT), Chronic Urticaria Quality of Life questionnaire (CU-Q2oL), and Dermatology Life Quality Index (DLQI) are effective tools for evaluating disease control in dermographism patients 2
- A medical history and provocation test or dermatographic test are the gold standard for diagnosis 2
- Skin prick test (SPT) with aeroallergens and laboratory results can help investigate possible relationships between triggering factors and associated diseases 5