Dermographic urticaria, which has other names - autographism, urticarial dermographism, dermatografic urticaria, is considered as a special kind of mechanical urticaria, which manifests itself with prolonged or short-term exposure to the skin of a mechanical stimulus. In this article we will look at the photos, symptoms and treatment of demographic( dermograph) urticaria, the causes of the appearance and peculiarities of the disease.
Features of
A factor that provokes autographism can be belt pressure, clothing friction, vibration, movement of the blunt object with pressure on the skin. In this case, the skin does not always itch, but reacts to provocation by the formation of swellings, redness, blisters that repeat the shape of the stimulus object or its trajectory. For example, if a patient scratches an itchy place, the whitish-pink stripes swelling over the skin will appear along the way.
To dermograficheskoy form also include urticaria from the effect of pressure, when skin reactions occur in the form of swelling and irritation after a time - 2 - 6 hours. For example, under a wristwatch after a long pressure, a blister in the shape of a bracelet around the wrist will swell. The same action can have tight compression stockings, tight shoes.
Autographism is observed in 8 to 13% of all urticaria. More often( 65 - 95%), the disease affects people predisposed to allergies, often leaking in parallel with other types of allergies - thermal urticaria, cold, cholinergic, dermatitis, edema Quincke. But with dermographic urticaria, the itch appears less often.
Urticaria dermographism( photo)
Classification of demographic urticaria
Form
Classify:
- primary form , which develops directly under the action of a provoking factor;
- secondary , when the disease is provoked by the existing internal pathology( mastocytosis, neurological diseases, systemic lupus, serum sickness).
About this autografism, this video will tell you:
reaction rate Three types of autographism are distinguished by the speed of reaction:
- immediate type ( more frequent), at which the skin reaction is visible after 2 to 5 minutes after pressure, remaining about half an hour;
- average , when swelling and irritation develops in the interval from half an hour to 2 hours and is kept until 3 - 9 hours;
- is a late ( a rare type), giving a skin reaction after 4 to 6 hours, which persists for 2 to 3 days.
With an average and late reaction, pruritus, tenderness, swelling and hyperemia appear in places where the body was exposed to a prolonged and severe pressure:
- on the shoulders after the straps of a backpack or shoulder bag;
- on the ankles after squeezing them with tight socks;
- on the wrists after the strap of the bag or bracelet;
- in any places, squeezed tight linen, belts;
- on the feet after a long walk;
- on the buttocks with a long sitting, on the skin from inside the hips after horseback and bike walks.
A clear sequence of skin changes is observed for all types: after the action of the physical stimulus there is reddening of the skin, then the reddened area swells, puffiness is formed, which increases, becoming wider.
By type of reaction
By type of reaction differentiate:
- Local dermographism of , in which skin reactions are limited to a site of irritation.
- Reflex , when changes in the skin after pressing and carrying a solid sharp object through the body appear after 5 to 20 seconds in the form of a bright red strip up to 6-7 mm wide. This phenomenon is explained by the expansion of small arterioles and is a typical vasomotor reflex.
By the manifestation of
There are several types of dermographism:
- Red , in which red or bright pink stripes appear on the skin, formed at a strong pressure by a blunt solid object. It is better expressed on the upper part of the body.
- White dermographism. For him - with a weak brief pressure - the appearance of white bands is characteristic, which is caused by spasm of capillaries. Stronger manifested on the legs and held for longer than the "red" dermographism. In contrast to the "red" such a vascular reaction is due not to the expansion, but to the narrowing of the capillaries.
- Dermographism is an elevated , at which red bands up to 60 mm wide with irregular contours are initially formed, which after 2 - 3 minutes are replaced by white, swelling over the skin, long-lasting blisters. Such skin changes are caused by high permeability of the vascular wall.
The following are the causes of urticaria dermographism.
Causes of
The medical analysis of the mechanism of the onset and development of dermographic urticaria and its variations is not complete. It has been found that painful changes in the skin under pressure, vibration, and depression are caused by the stimulation of mast cells. In response to provocation, they actively throw large amounts of histamine into the blood - the regulator of allergic reactions - which activates processes that increase the permeability of the microvessel wall, which further determines the nature and severity of the symptoms.
Skin coloring at stroke pressure is associated with:
- by the extension of ( red autographism) or
- by narrowing ( white form) of small vessels providing blood supply to the skin.
But it is not clear why the skin of different patients reacts to this or that type.
It has been established that urticarial dermographism affects people:
- with hereditary predisposition to disease;
- after a viral infection;
- with a special emotional instability;
- after severe stress, prolonged nerve strain;
- after poisoning with ethanol, heavy metals, other toxins.
Symptoms of
The symptoms of autographism depend on the type of the disease, but in any case - with mechanical irritation of the skin the basic signs remain as follows:
- appearance of red, pink, whitish bands directed along the action of the stimulus or repeating its shape;
- itching, swelling, burning and sensation of skin tension;
- swelling of the skin in the form of blisters.
A feature of dermographism, unlike many other allergic skin reactions, is the frequent absence of itching or its very weak intensity.
Types of dermographism and symptoms Table 1
| Response | Kind of dermographism | Basic symptoms of | May occur | Onset and duration of |
|---|---|---|---|---|
| immediate | white( weak fast pressure);red, strong, longer pressure) | bands red or white, blisters, erythema( redness) | Itching, burning, soreness, general weakness, chills, headache, nausea | appear in the range of 3 seconds to 10 minutes after pressure on the skin; is kept 0.5 - 2 hours |
| mixed | red band surrounded by white border | |||
| delayed | red, after prolonged exposure to | red, itchy, painful blisters in the form of | provocateur appear between 0.5 and 9 hours after physicalskin irritation;stored about 36 hours | |
| mixed | elevated | 1st stage: red uneven stripes; Stage 2: whitish linear blisters that rise above the skin( similar to blisters from burns), surrounded by the pink-red area of the | , the duration of stage 1 is 2 to 3 minutes; 2 stage lasts from half an hour to 36 hours. |
Diagnosis
It is easy to detect dermatographic urticaria of immediate type. The allergist irritates the skin with a blunt spatula, passing them along the patient's body with an average pressure level. Appearance in 3 - 20 minutes on a site of irritation of red or white strips, blisters confirms the diagnosis.
A delayed type of dermographism is more difficult to detect, since all signs develop several hours after prolonged pressure on the body.
Whether dermographism is possible to treat urticarum, we learn further.
Treatment
Therapeutic way
Local remedies for skin manifestations - itching, erythema, edema: Radevit, Elidel, Psilo-balm, Protopic, Eplan, La Cree, Skin Cap. Glucocorticoid external agents help in severe cases.
They are divided by their effects:
- Weak glucocorticoid ointments: Sinaphlan, Flucin, Laticort, Hydrocortisone.
- Medium: Afloderm, Fluorocort, Triamcinolone;Strong
- : Advantan, Celestoderm B Lokoid, Elokim Kloveyt, Dermoveyt
medicated method
Dermograficheskuyu urticaria treated by the same groups of medicines, as other types of urticaria. First of all, antiallergic drugs of different generations are used, which are selected depending on the individual reaction of the patient to a particular medicine.
- Some doctors recommend vasoconstrictors with a red form of dermograph and vasodilator - with white.
- Others are opposed to this treatment option, such as the effect of drugs on the body - a common, so - their influence extends to vessels of all organs, including the brain and heart. Because the use of vasodilators( vasodilator) or opposing action of drugs can lead to problems in the blood supply to the brain and coronary vessels or their abrupt expansion that threatens hemorrhagic stroke, thromboembolism.
The treatment regimen for urticarial dermographism is discussed further on the items.
Antihistamines II - III generation
Therapy is usually started with the use of standard doses of antihistamine II - III generation. Daily dosages for adults:
- Claritin, Lomilan( loratadine) - 10 mg;
- Telfast, Fexadine( fexofenadine) 150 mg. Strictly forbidden to pregnant, nursing, children under 6 years;
- Xizal, Suprastinex, Zodac, Glencet, Ceser( levocetirizine) - 5 mg, contraindications are the same as those with fexofenadine;
- Ebastin( piperedin) - 10 mg;
- Erius, Allergostop( desloratadine) - 5 mg;
- Zirtek, Zodak( cetirizine) - 10 mg.
A new drug that works well for dermal urticaria, but does not cause sedation( drowsiness) - Trexyl with the active ingredient terfenadine. Use in tablets and suspensions. The recommended dose for adult patients, starting at age 12, is 60 mg( or 10 ml of suspension) 2 times. Children's doses: 3 - 7 years, 15 mg, 7 - 12 years - 30 mg, morning and evening.
If antistamines of the last generation do not help, dosages do not usually increase, but a second drug with another active substance is added to the therapy regimen.
Or use the means of 1 generation, often more effective in hives: Dimedrol, Suprastin, Tavegil, Pipolphen. In severe skin manifestations with severe itching Tavegil, Suprastin is administered intramuscularly.
For frequent exacerbations of long-term dermographism, use:
- Ketotifen. An adult dose of 0.001 - 0.002 g twice daily. Children are given a syrup: up to six months - in a daily dose at the rate of 0.05 mg per kilogram of the baby's weight, from half a year to 3 years - twice a day for 0.5 mg, from 3 years - 1 mg.
- Cyproheptadine: 4 to 8 mg( 3 or 4 times);the infant dose, based on the norm of 0.25-0.5 mg / kg, is also divided into 3 to 4 doses.
H2-receptor antagonists of histamine
If the patient does not respond to antiallergic medication, try injecting H2 receptor suppressing agents:
- Cimetidine: 0.3 grams up to 4 times a day. Children's daily doses from one-year-old age are calculated: 25 - 30 mg per 1 kg of weight, for babies up to a year - at the rate of 20 mg / kg of weight;
- Ranitidine for patients older than 12 years for 0.150 to 0.300 g( 2 or 1 times a day);
- Famotidine( from 12 years old) - twice in 0.020 g.
Hormonal remedies
In those rare cases when the severity of symptoms does not decrease, short courses( 2 to 4 days) are necessary to use hormones that quickly relieve swelling and itching.
Prednisolone is usually prescribed in a daily adult dose of 0.04-0.06 grams, Dexamethasone 0.004-0.020 g( or 1 injection per day) in the acute period.
Elimination of general symptoms of
Common symptoms are resolved by taking:
- Paracetamol, Ibuprofen, Ketonal for painful blisters, headache, temperature;
- Tserukal - with nausea;
- Decitel, No-Shpu - with spasms in the abdomen.
Because the specialists associate the development of dermographic urticaria with the instability of the nervous system, prescribe courses:
- vitamins of group B, including Neuromultivitis, Milgamma, vitamins B1, B6, B12 in injections;
- sedatives: decoctions, tinctures, tablets with the root of valerian, motherwort, Novopassit;
- in the period of exacerbations - Bellantaminal, Belloid( tablet 3 times / day).
Since skin manifestations associated with dermis hives are associated with an abnormally high permeability of the vascular wall,
- ascorbic acid;
- flavonoids( Rutin, Ascorutin, Quercetin, Vitamin P) under the control of blood coagulability to avoid increased viscosity;
- vitamers( semi-synthetic derivatives) - Venoruton, Flebodia, Detrolex, Troxevasin in various forms( capsules, gel, solutions).
With heavily tolerated symptoms - severe itching, insomnia, neurological disorders, it is desirable to use trenquilizers from the benzodiazepine group( Phenazepam, Xanax, Diazepam) and antidepressants - Paxil, Doxepin.
Prevention of the disease
To exacerbate dermographism less often, it is necessary:
- Avoid situations involving pressure on the skin, especially - prolonged, accompanied by friction.
- Do not wear clothes made of synthetic or woolen fabrics.
- Do not use hard wool, do not rub the body with a towel.
- Exclude power massage( only stroking type).
- Avoid overwork, stress, overheating and cooling, which can become disease provocateurs.
- To conduct consultations and examinations with the gastroenterologist to prevent infection of the gastric mucosa by the helicobacter pylori bacterium, endocrinologist( diabetes mellitus, thyroid disease), parasitologist( to identify possible lambliasis, helminthiases), immunologist.
Complications of
With the development of urticaria dermographism, the consequences can be as follows:
- Frequent exacerbations of urticaria deplete the nervous system of patients, leading to depression.
- Prolonged pressure, often repeated in the same places, contributes to thinning, damage to the dermis. At the same time, pyogenic bacteria easily penetrate into the interior, leading to pustular infections of the skin, furunculosis, local suppuration with development of an abscess.
- General symptoms of malaise, which often accompany skin reactions - temperature, nausea, headaches - contribute to the fall of the body's immune defenses.
- Since any allergic diseases are "backed up" by other types of allergy, dermographic urticaria is rarely complicated by Quinck's swelling, a dangerous laryngeal edema, anaphylactic shock.
Forecast
Timely diagnosis and treatment undertaken slow down and alleviate the disease. Strengthening the immune system, the vascular wall, the nervous system contribute to the easy flow of pathology.
This video provides useful information on dermograph and other types of urticaria: