Demographic urticaria( urticarial dermographism): symptoms and treatment, causes
Dermograficheskuyu urticaria, and having other names - autografizm, urticarial dermographism, urticaria dermatograficheskaya considered as a special kind of mechanical urticaria, which manifests itself in the long or short-term exposure to the skin of the mechanical stimulus.In this article we will look at the photos, symptoms and treatment of demographic( dermograph) urticaria, the causes of the appearance and the peculiarities of the disease.
autografizm provoking factor can be a pressure belt, clothing friction, vibration, movement of the skin with pressing a blunt object. 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
Autographism is observed in 8 to 13% of all hives.Most often( 65 - 95%) the disease affects people who are predisposed to allergies, often flowing in parallel with other types of allergies - heat urticaria, cold, cholinergic, dermatitis, angioedema.But with dermal urticaria itching appears less often.
urticaria dermographism( photo)
Classification demographic urticaria
- primary form , which develops directly under the action provoking factor;
- secondary , when the disease is provoked by the existing internal pathology( mastocytosis, neurological diseases, systemic lupus, serum sickness).
That is autografizm, tell this video:
of the reaction rate
of the reaction speed are three types autografizma:
- immediate type ( more frequent), whileWhich skin reaction is visible after 2 to 5 minutes after the 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 shoulder straps of a backpack or shoulder bag;
- on the ankles after squeezing them with tight socks;
- on the wrists after the strap of a 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 of skin changes: after the action of the physical stimulus, reddening of the skin occurs, then the reddened area swells, puffiness is formed, which increases, becoming wider.
By differentiating the type of reaction:
- Local dermographism , wherein the skin irritation reaction limited portion.
- 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 with a width of 6-7 mm.This phenomenon is explained by the expansion of small arterioles and is a typical vasomotor reflex.
There are several types dermographism:
- Red , in which red or bright pink bands appear on the skin, formed at a strong pressure by a blunt solid object.Better expressed on the upper part of the body.
- White dermographism.For him - with a slight 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 elevated , in which red bands up to 60 mm wide with uneven contours are initially formed, which after 2 - 3 minutes are replaced by white, swelling over the skin, with long-lasting bubbles.Such skin changes are caused by high permeability of the vascular wall.
The following are the causes of urticaria dermographism.
The medical analysis of the mechanism of the onset and development of dermographic urticaria and its variations is not complete.It has been established that painful changes on 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, the regulator of allergic reactions, into the bloodstream, which activates processes that increase the permeability of the microvessel wall, which further determines the nature and severity of the symptoms.
Skin coloring at bar-pressure is related to:
- by the extension ( 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 viral infection;
- with a special emotional instability;
- after severe stress, prolonged nerve strain;
- after poisoning with ethanol, heavy metals, other toxins.
The symptoms of autographism depend on the type of disease, but in any case - with mechanical skin irritation, the basic characteristics 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 Dermatogram type basic symptoms may appear 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 afterPressure on the skin;
held for 0.5-2 hours
mixed red stripe surrounded by white border delayed red, after prolonged exposure to red, itchy, painful blisters in the form of a provocative object appearIn the interval from 0.5 to 9 hours after physical stimulation of the skin;Stored for 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.
It is quite 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 slow 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.
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 according to their effects:
- Weak glucocorticoid ointments: Sinaphlan, Flucinar, Laticort, Hydrocortisone.
- Medium: Afloderm, Fluorocort, Triamcinolone;
- Strong: Advantan, Celestoderm B, Lokoid, Elokom, Cloveit, Dermovayt
Dermographic urticaria is treated with 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 negative about this treatment option, since the effect of such medications on the body is general, which means that their effect extends to the vessels of all organs, including the brain and the heart.Therefore, the use of vasodilators( vasodilators) or drugs that are opposite in effect can lead to problems in the blood supply of the cerebral and coronary vessels or to a sharp expansion of them, which threatens hemorrhagic stroke and thromboembolism.
The treatment regimen for urticarial dermographism is discussed further below.
Antihistamines II - III generations
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 up to 6 years;
- Xisal, Suprastinex, Zodac, Glencet, Cesera( 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 an active component of 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 1 generation drugs, often more effective in hives: Diphenhydramine, 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.
Suppressors of H2-receptor histamine
If the patient does not respond to therapy with antiallergic medicines, try introduction of agents that suppress the H2 receptors of histamine:
- Cimetidine: 0.3 grams up to 4 times a day.Children's daily doses from a year's 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) - twice in 0.020 g.
In those rare cases where the severity of symptoms does not decrease, it is necessary to use short hormones( 2 to 4 days) to use hormones that quickly removeSwelling 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
General symptoms are resolved by taking:
- Paracetamol, Ibuprofen, Ketonal for painful blisters, headache, temperature;
- Tserukal - with nausea;
- Decitel, No-Shpu - with spasms in the abdomen.
Since specialists associate the development of dermographic urticaria with the instability of the nervous system, the following are prescribed courses:
- B vitamins, 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 - Bellanthinal, 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).
In patients with severe symptoms( especially severe itching, insomnia, neurological disorders, it is desirable to use tranquilizers from the benzodiazepine group( Phenazepam, Xanax, Diazepam) and antidepressants - Paxil, Doxepin.
Prevention of the disease
To exacerbate dermographism less frequently, 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.
- Eliminate the power massage( only the type of stroking).
- Avoid overwork, stress, overheating and cooling, which can become disease provocateurs.
- To conduct consultations and examinations with a gastroenterologist to prevent infection of the gastric mucosa by the Helicobacter pylori bacterium, endocrinologist( diabetes mellitus, thyroid disease), parasitologist( identify possible lambliasis, helminthiases), immunologist.
When developing urticaria dermographism, the consequences may be as follows:
- Frequent exacerbations of urticaria deplete the nervous system of patients, leading to depression.
- Prolonged pressure, often repeated at 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 the 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 allergies, dermographic urticaria is rarely complicated by Quinck's swelling, a dangerous laryngeal edema, anaphylactic shock.
Timely diagnosis and treatment taken slow and alleviate the disease.Strengthening the immune system, the vascular wall, the nervous system contributes to the easy flow of pathology.
This video provides useful information about dermograph and other types of urticaria: