Association of dermographic urticaria with the use of progesterone in cottonseed oil

Shedding light on dermographism: a narrative review

Dermographism is a common subtype of chronic urticaria. It generally manifests as a linear wheal after scratching or friction, with or without angioedema. The pathophysiology is not clear, but currently, we believe that the stimulation of the skin by mechanical stress leads to the activation of mast cells, which provoke the release of histamine and pro-inflammatory mediators, ultimately forming wheal along the stressed area. The gold standard for diagnosis is a medical history and provocation test or dermatographic test. As one of the subtypes of chronic urticaria, the Urticaria Control Test (UCT), Chronic Urticaria Quality of Life questionnaire (CU-Q2oL), and Dermatology Life Quality Index (DLQI) are also effective tools for evaluating disease control in dermographism patients. In addition to avoiding triggers, nonsedating H1 antihistamines are the first-line medications recommended by EAACI and other guidelines; for those who do not respond to standard doses, the recommended dosage can be increased up to 4 times. When necessary, the off-label use of omalizumab can be considered, and some drugs with potential therapeutic effects are still being explored. However, there is still a lack of biomarkers for predicting disease severity, efficacy, and prognosis. Here, we review what we know about dermographism and some points that need exploration in the future.

Inducible urticaria: Case series and literature review

Inducible urticaria is a heterogeneous group of skin disorders characterized by the appearance of wheals, pruritus and/or angioedema, sometimes accompanied by systemic symptoms caused by innocuous stimuli (cold, heat, pressure, etc.). This group of disorders compromises people's quality of life and most of the literature in this regard comes from case reports and case series since its epidemiology has been poorly studied and some cases are very rare. The aim of this review is to show an up-to-date overview of the available literature for various types of inducible urticarias, always beginning with an illustrative case and then describing their pathophysiological mechanisms, clinical manifestations, and treatment.

Physical urticaria

The physical urticarias are a heterogeneous subgroup of chronic urticarias in which wheals can be reproducibly induced by different specific physical stimuli such as cold, heat, pressure, vibration, or sunlight. Physical urticarias comprise up to 25 % of chronic urticarias and occur more frequently in young adults. Symptoms, i.e. wheal and flare responses or angioedema, are usually limited to the skin areas exposed to the eliciting stimulus. However, generalised urticaria with variable extracutaneous manifestations can also occur. Some patients may also present with more than one physical urticaria. Skin lesions in physical urticaria result from mast cell activation and mediator release. The mechanisms by which physical stimuli activate skin mast cells are not fully understood. Because of this, trigger avoidance and symptomatic treatment are key therapeutic concepts for physical urticarias. Identification of the inducing physical trigger, including its individual thresholds, is necessary for an effective therapy. Here, we have summarized clinical features, diagnostic workup and therapy options for physical urticarias.