What is the medical term for skin pressure that causes redness and raised marks?

Dermographism and Delayed Pressure Urticaria: Skin Pressure Reactions

The medical term for skin that becomes red and raised after pressure application is dermographism (for immediate reactions) or delayed pressure urticaria (for delayed reactions), both of which are physical urticarias triggered reproducibly by mechanical pressure stimuli. 1

Types of Pressure-Induced Skin Reactions

Symptomatic Dermographism

• Appears within minutes after skin exposure to pressure or mechanical irritation
• Characterized by wheals (raised areas) and erythema (redness)
• Occurs when "normal" pressures from daily activities cause urticaria 2
• Individuals with symptomatic dermographism have a lower pressure threshold than normal individuals

Delayed Pressure Urticaria

• Deep swellings develop at sites of pressure application on the skin
• Reactions appear 4-6 hours after sustained pressure and can last 24-48 hours
• Often associated with pain rather than itching
• Can significantly impact quality of life 3
• May coexist with chronic "idiopathic" urticaria 4

Clinical Presentation and Diagnosis

Clinical Features

• Symptomatic dermographism: Immediate whealing and erythema after stroking or scratching the skin
• Delayed pressure urticaria: Deep, painful swellings at pressure sites (e.g., after carrying heavy bags, sitting on hard surfaces, wearing tight clothing)
• Physical urticarias account for up to 25% of chronic urticarias and occur more frequently in young adults 5

Diagnostic Testing

• Challenge tests can confirm the diagnosis:
  • For dermographism: Stroke the skin with a blunt object (dermographographism test)
  • For delayed pressure urticaria: Apply sustained pressure to the skin (e.g., weighted rods or sandbags) and observe for reactions after 4-6 hours 1, 3
• Skin biopsy may be performed in atypical cases to rule out urticarial vasculitis

Management Approaches

Avoidance Strategies

• Identify and avoid specific pressure triggers when possible
• Minimize mechanical stress on the skin
• Lifestyle modifications to reduce pressure exposure 6

Pharmacological Treatment

• H1-antihistamines are first-line therapy but may be less effective for delayed pressure urticaria compared to other urticarias 4
• For severe cases resistant to antihistamines:
  • Oral or topical corticosteroids (short-term use)
  • Anti-inflammatory medications
  • Immunosuppressive agents in refractory cases 4, 3

Special Considerations

Differential Diagnosis

• Urticarial vasculitis (defined by vasculitis on skin biopsy)
• Other physical urticarias (cold, heat, solar)
• Contact urticaria (from allergens or chemicals)
• Palmar-plantar erythrodysesthesia syndrome (PPES) in patients receiving chemotherapy 1

Impact on Quality of Life

• Delayed pressure urticaria can significantly impact daily activities and quality of life
• Pain and discomfort may limit physical activities
• Psychological support may be beneficial for patients with chronic symptoms 3

Prognosis

• Course is variable and often chronic
• Some patients experience spontaneous resolution over months to years
• Others may require long-term management strategies 6

Understanding the specific type of pressure-induced skin reaction is crucial for appropriate management and improving patient outcomes.