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Question answered:25/07/07 Warning! this question is over two years old.
The CKS guideline on urticaria refers to dermographism and notes:
“Physical stimuli:
The most common physical urticaria is dermographism. It affects 5% of the population, with a rash that develops on an area of skin that has been rubbed firmly.”
How do I manage a first episode of urticaria?
Confirm the diagnosis and try to identify the cause considering:
…Systematic enquiry, including ENT (ear, nose and throat) problems (e.g. rhinitis), gastrointestinal problems (diarrhoea, malabsorption), autoimmune disorders (diabetes, thyroid), atopy, and skin disorders.
How should I manage persist or recurrent urticaria?
“Manage any underlying associated diseases (e.g. H. pylori infection, thyroid disease, connective tissue disorder), although there is no strong evidence that correcting these conditions will improve the urticaria itself…” [1]
“What assessment do I need to make?
• …Consider the following investigations:
? Full blood count (FBC) looking for iron, B12 and folate deficiency.
? Stool sample (if intestinal parasites suspected).
? Erythrocyte sedimentation rate (ESR).
? Thyroid function tests (including autoantibodies).
? Liver Function Tests (LFTs) and H. Pylori screening if gastrointestinal symptoms are present.” [1]
An e-Medicine article on dermographism urticaria notes:
“Causes: Symptomatic dermographism is usually idiopathic. It may have an immunologic basis in some patients. Passive transfer of the dermographic response with immunoglobulin E– or immunoglobulin M–containing serum has been reported but no allergen has been identified.
• Symptomatic dermographism may be triggered by drugs (eg, penicillin), an insect bite, Helicobacter pylori infection, or an infestation (eg, scabies, Fasciola hepatica)…” [2]
A search in the TRIP and Medline databases found one reference – a case study – to dermographism and helicobacter pylori. The Medline abstract reads:
“This paper describes a 36 year-old white woman with six month history of epigastric abdominal pain, reactive arthritis and painful dermographism. Serum antibodies to Helicobacter pylori were identified. All symptoms subsided when she received eradication treatment.” [3]
References
1. CKS. Urticaria. Last revised April 2007. (http://cks.library.nhs.uk/urticaria/)
2. Laube S. Dermographism urticaria. E-Medicine. February 2007. (http://www.emedicine.com/derm/topic446.htm).
3. Morfín Maciel BM and Castillo Ramos HA. [Reactive polyarthritis and painful dermatographism caused by Helicobacter pylori]. Rev Alerg Mex. 2002 May-Jun;49(3):99-102. (http://www.hubmed.org/display.cgi?uids=12190006).
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