Although skin writing may sound exotic, dermatographia is a common condition, affecting 2 to 5 percent of the population. It is considered one of the more prevalent forms of hives and accounts for 7 to 10 percent of all cases of skin rashes and swelling.
With simple dermographism people develop welts after rubbing their skin, any brief contact with it, or scratching, but the resulting hives do not itch.
Contents of this article:
- The condition is commonly referred to as skin writing.
- Episodes of dermatographia usually come and go quickly.
- In people with this condition, rubbing or scratching the skin with a finger causes welts that resemble writing.
- Dermatographia hives frequently appear on the scalp, in the genital area, and on the soles of the feet.
Causes and risk factors
Image credit: R1carver, (2009, November 21).
The consensus among medical professionals is that dermatographia is an allergic reaction when specific antibodies (IgE and IgM) are released in response to scratching, pressure, or mild irritation of the skin. This response prompts the release of histamines, which cause the welts.
In general, researchers do not expect to find a strong genetic link to dermatographia, although 14 percent of those surveyed in a recent study reported a family history of the condition.
Skin writing is often seen in young adults.
The following factors may make the condition worse:
- alcohol use
More than 80 percent of those contacted by researchers in this study said their symptoms were worse at night.
Moisturizing the skin may help to ease the symptoms of dermatographia, such as itchiness.
The reaction develops rapidly, within 5 to 7 minutes after the skin is disturbed. It typically disappears within 15 to 30 minutes, although sometimes the welts may last longer.
Welts or hives erupt where the skin has been irritated, rubbed, or scratched, and in areas where clothes rub against the skin, such as shirt collars and cuff lines or sock lines.
These raised marks on the skin appear in a straight-line and are called linear weals. If a general pressure is a cause, the rash is more diffuse.
Dermatographia symptoms are usually worse at night. Alcohol, stress, and high temperatures can increase the itching and associated discomfort.
What are the treatment options?
Over-the-counter, nonsedating antihistamines are commonly the first step in treating dermatographia.
The prescription drug known as cromolyn has also been effective in treating some cases.
Antihistamines do not work for all individuals with skin writing, but there are alternative treatments that may help with the symptoms.
Advocates of alternative treatments for dermatographia recommend:
- following a healthy diet, emphasizing fresh fruits and vegetables and low in high fat, processed foods
- staying hydrated by drinking water and avoiding alcohol and beverages with added sugar
- moisturizing skin with natural products, such as coconut oil or shea butter
- practicing self-care by getting enough rest and nurturing the body and mind
- cooling the itching with cold compresses, chilled aloe vera gel, apple cider vinegar, or cold running water
People with the condition are often advised to avoid foods that may promote inflammation, including:
- red meat
- processed meat
- fried foods
- refined carbohydrates
- beverages sweetened with sugar
Diagnosis and when to see a doctor
A diagnosis may be made by looking at the patient's history of skin conditions, including hives.
Individuals with a history of hives should see a doctor or a dermatologist.
To prepare for the appointment, an individual should put together a record of outbreaks of skin writing and skin disturbances.
Things to record include:
- the clothing worn at the time, as it may have contributed to the response
- environmental factors
- eating and drinking habits
Doing this will help doctors make an accurate diagnosis and help individuals identify potential triggers for their outbreaks.
A doctor will conduct a physical examination and review someone's personal and family medical histories.
Dermatographia is described as an inducible urticaria, which means hives develop in response to something specific, for example an ice cube for people who have cold urticaria.
It is standard practice for a doctor diagnosing suspected cases of this condition to replicate potential triggers. Hence, they may try scratching a person's skin with a tongue depressor.
In some cases, the doctor may use a dermagraphometer to measure the skin's response to pressure.
One of the most important things that people with dermatographia can do is identify the triggers that worsen their condition.
Triggers can include heat, activity, and emotional circumstances. For example, 44 percent of participants in one study said stress could cause acute episodes of skin writing.
The following recommendations may help reduce the severity of episodes of dermatographia:
- practicing good skin care and avoiding using soaps, lotions, or other products that may dry or irritate the skin
- avoiding wearing itchy fabrics, such as wool
- using moisturizer frequently
- making sure clothing is loose and not constricting
- avoiding taking very hot or very cold showers or baths
- being gentle when towel-drying after swimming or bathing
- eating lots of noninflammatory foods, such as seafood rich in omega-3 fatty acids, leafy greens, including kale and spinach, tomatoes, fruits, and olive oil
- wearing sunscreen and avoiding overexposure to sunlight
Individuals have differing experiences with dermatographia. For some people, it resolves completely within a few months, and for others it continues for years. Some reports suggest that, for many people, the condition either disappears or stabilizes enough to no longer be a problem within 1 to 2 years.
According to a study published in the Journal of the European Academy of Dermatology and Venereology, dermatographia has a mean duration of 6.5 years. Only 1 out of 4 people with the condition reported extensive periods of remission in this time. Some people with the condition can expect to have it for the rest of their lives.
Close to half, or 45 percent, of the participants in one study said their symptoms were moderate. But 44 percent said the condition significantly impaired their quality of life. Only 7 percent said normal life was not possible.