What is the first line of treatment for Dermographia?

First-Line Treatment for Dermographia

Non-sedating H1 antihistamines are the first-line treatment for dermographia, with the option to increase dosage up to four times the standard dose if symptoms persist. 1

Understanding Dermographia

Dermographia (also called dermographism) is a common form of chronic inducible urticaria characterized by:

• Linear wheals that form after scratching or friction on the skin
• Accompanied by itching and sometimes burning sensations
• Can be triggered by even light pressure or rubbing from clothes
• Affects approximately 1.5-5% of the population

Treatment Algorithm

First-Line Treatment

• Non-sedating (second-generation) H1 antihistamines
  • Start with standard dosing once daily
  • Examples include loratadine 2, cetirizine, fexofenadine, or desloratadine
  • These are effective and well-tolerated with minimal side effects 3

If Inadequate Response After 2-4 Weeks

• Increase H1 antihistamine dosage
  • Can be increased up to 4 times the standard dose 1
  • For example, loratadine 10mg can be increased to 20mg twice daily

For Refractory Cases

• Combination therapy with H1 + H2 antihistamines
  • Adding an H2 antihistamine (such as ranitidine or famotidine) to an H1 antihistamine provides greater inhibition of the dermographic response 4
  • This combination has shown superior efficacy compared to H1 antihistamines alone

For Severe, Treatment-Resistant Cases

• Consider omalizumab
  • Has shown efficacy in refractory cases 3
  • Should be considered when standard treatments fail

Additional Management Strategies

• Identify and avoid triggers:

  • Tight clothing
  • Excessive heat or cold
  • Stress (reported as a trigger in 44% of patients) 5
  • Friction from towels or bedsheets

• Skin care:

  • Use gentle, fragrance-free cleansers
  • Apply emollients regularly to maintain skin barrier function 6
  • Avoid hot showers or baths

Important Considerations

• Quality of life impact: Dermographia significantly impairs quality of life in 44% of patients, with 7% reporting they cannot lead a normal life 5

• Disease course: The average duration is about 6.25 years, but approximately 25% of patients experience prolonged symptom-free phases 5

• Associated conditions: Consider evaluating for:

  • Psychological factors (reported as initial triggers in 30% of cases) 7
  • Atopy (present in 12.5% of patients) 7
  • Thyroid disease (particularly hyperthyroidism) 7

Treatment Efficacy

• With appropriate H1 antihistamine treatment:
  • 49% of patients report marked improvement
  • 23% become symptom-free 5
  • Most patients require ongoing treatment

Monitoring

• Assess response to treatment after 2-4 weeks
• If symptoms persist despite standard dosing, consider dose escalation
• For patients with severe or refractory symptoms, referral to a dermatologist or allergist is recommended