Dermatographia is an unusual chronic condition, also referred to as skin writing, and dermographism or dermatographic urticaria. It is considered one of the many forms of dermatitis.

This condition is believed to affect between 2% to 5% of the general population, primarily young adults. For some individuals, the condition clears up after a year or two, while for others, it lasts a lifetime. This article explores its potential causes, triggers, risk factors, and treatment options, along with informative tips to help your client deal with the condition.

CAUSE

The exact cause is unknown. We do know that the skin is highly susceptible to touch. It may be a weakened immune system that triggers mast cells to release abnormal amounts of histamines without a normal immune response signal from an allergen.

Medical professionals believe that dermatographia is an allergic reaction when specific antibodies immunoglobulin e (IgE) and immunoglobulin m (IgM) are released in response to either scratching, pressure, or mild irritation of the skin.

A client with dermatographia is hypersensitized to either touch, certain chemicals, heat, cold and pressure, a combination, or all of the above.

Sensory receptors found in the epidermis detect and respond to the various sensations acting as the catalyst in the immune system’s response, which initiates the histamine release from the dermal mast cells.

Some individuals have developed the condition after having a traumatic event like a car accident, while for others, the condition has simply appeared with no explanation.

PRESENTATION

The client may receive a slight scratch, which develops into a red, raised mark on the skin produced from the release of histamines. The mark usually dissipates within half an hour unless an irritant is causing the client to continue to scratch their skin.

DIAGNOSIS

A dermatologist will assess the skin then rub an instrument against it (usually something gentle like a tongue depressor) in a specific direction. A welt will appear mimicking the inflicted mark within seven minutes if the patient has dermatographic urticaria.

TRIGGERS

Individuals can avoid outbreaks by refraining from any known triggers, which include the following:

• Rubbing or pressure on the skin
• Any irritant that causes itching
• Heat (hot showers or the sauna)
• Stress
• Forms of exercise that involve skin rubbing (wrestling can be one example)
• Dry weather
• Infection
• Certain medications including penicillin

TREATMENT

There are a variety of methods that the client may try to find relief.

Because itchiness is triggered by histamine release, antihistamines are often suggested to suppress the itching. Common antihistamine medications include Benadryl, Allegra, Zyrtec, or Xyzal. Individuals should always speak to a physician before taking a new drug, as certain medications can react unfavorably with prescriptions that are currently being taken.

A prescribed injection of omalizumab, which is prescribed to reduce sensitivity to allergens, may be an option for severe cases.

Moisturizers intended for dry skin with anti-itch ingredients like hydrocortisone or bisabolol are also used.

It is important to drink adequate amounts of water to keep the skin hydrated. The kitchen can contain home remedies to provide moisture to dry skin, including olive and coconut oils. Aloe vera and oatmeal are two excellent anti-inflammatories that can assist in calming the skin. Phototherapy may be recommended for extreme cases.¹

RISK FACTORS FOR DEVELOPMENT OF THE CONDITION

These red flags may be indicators of the condition:

• dry skin
• a nervous disorder, illness, or disease that causes the skin to be itchy
• history of dermatitis
• young adulthood
• experiencing frequent scratches
• heredity, as it appears that dermatographia may run in families

LIVING WITH THE CONDITION

It’s never easy living with any health condition. Here are a few tips to make life with dermatographia a bit more tolerable. Individuals should eat a healthy diet avoiding alcohol, dairy, caffeine, and sugar; and incorporating fruits, vegetables, and foods high in the omegas, like avocado and salmon, that boost immune system health. Avoiding hot showers is recommended. Loose-fitting clothes are beneficial.² Individuals should not wear any fabric that is itchy (like wool), should pat the skin dry after cleansing or bathing, and should avoid harsh soaps.

POSSIBLE THEORY

Cortisol and stress are linked to dermatographia. Cortisol is an anti-inflammatory hormone released by the adrenal glands. When the body senses stress, it releases cortisol. If the adrenal glands do not release enough cortisol (due to adrenal fatigue or an immune system weakness), more histamine is released by the mast cells, which produces a higher level of pruritis (itchiness) and urticaria (hives and welts).

Professionals experience many common conditions that concern their clients and, occasionally, a few that might stump them. Help your clients by becoming an intellectual sponge, absorbing all the information that you can to perform an effective skin analysis, and when necessary, referring them to the appropriate professional to receive a diagnosis and treatment for their skin concern(s).

References

1 Cherney, Kristeen. “What is Dermatographia.” Healthline.com. Apr 2019. 

https://www.healthline.com/health/dermatographia#treatment.

2 “Dermatographism (Dermatographia): Management and Treatment.” Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/17793-dermatographism-

dermatographia/management-and-treatment.

Brenda Linday, L.E., L.E.I., C.A.C., Linday Aesthetic Consulting, is a licensed aesthetician, licensed aesthetic instructor, and certified aesthetic consultant with over 16 years’ experience in the medical aesthetic industry. Linday serves as a consultant for medical and aesthetic companies desiring to build strong sales and education teams. She develops clinical and sales education content, and trains sales and educational units, clinicians, physicians, and distributors around the world. Linday is also a featured author in many industry publications. Her passion is sharing her wealth of knowledge with other like-minded professionals who believe that education is the key to building lasting relationships with our clients, making each clinician more successful by increasing client satisfaction. Reach her at This email address is being protected from spambots. You need JavaScript enabled to view it. or @LindayConsult.