Dermographism — SCE Dermatology MCQ

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EasyInflammatory DermatosesDermographismSCE Dermatology

A 30-year-old man has dermographism (symptomatic dermographism/dermatographic urticaria). Firm stroking of the skin produces a linear wheal within 5-10 minutes that resolves within 30 minutes. What is the first-line treatment?

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Correct answer: C — Non-sedating second-generation H1-antihistamine (e.g. Cetirizine)

Symptomatic dermographism is the most common form of chronic inducible urticaria (affecting approximately 5% of the population). Linear wheals appear within minutes of firm skin stroking and resolve within 30-60 minutes. First-line treatment is a continuous non-sedating second-generation H1-antihistamine at standard dose, increasing up to fourfold if needed. Most patients achieve adequate control with antihistamines. Omalizumab is third-line per EAACI guidelines. Dermographism is differentiated from delayed pressure urticaria (which occurs 4-6 hours after sustained pressure and is more difficult to treat). Diagnosis is confirmed by a dermographometer or firm skin stroking.

Reference: EAACI/GA²LEN 2022 Urticaria; BAD