Case Report: Dermatographic Urticaria in a 67-Year-Old Female | Village Dermatology Katy & Houston, TX
Introduction
Dermatographic urticaria, also known as “skin writing,” is a form of physical urticaria where light scratching or pressure on the skin causes red, raised, itchy welts. While often benign and self-limiting, the condition can be bothersome and impact quality of life. At Village Dermatology in Katy and Houston, Texas, we evaluate and manage urticaria with individualized care plans to reduce discomfort and improve skin health.
Patient Presentation
A 67-year-old female presented with:
An itchy, red rash on the right arm and right leg
Moderate severity, ongoing for several months
Rash appears intermittently and typically resolves within 30 minutes
Past treatment included oral prednisone with limited improvement
Examination
A focused dermatologic exam revealed:
Erythematous, linear, edematous plaques induced by scratching
Findings consistent with acute urticaria with dermatographism
No other concerning lesions identified
The patient was otherwise well-nourished, alert, and in no acute distress.
Diagnosis
Dermatographic Urticaria (L50.3)
Management Plan
Medications
Zyrtec (cetirizine): Patient was already taking 10 mg twice daily; dose increased to 20 mg twice daily as tolerated
Triamcinolone acetonide 0.1% cream: Prescribed for application twice daily to affected areas for 2 weeks, with instructions to use as needed for flares
Counseling & Education
The patient was counseled on:
Skin care: Use bland emollients to reduce scratching and maintain skin barrier health
Expectations: Dermatographism affects 2–5% of the population and is often idiopathic; most cases are benign
When to contact office: If symptoms worsen, fail to improve, or become more symptomatic
Follow-Up
Return in 2 weeks for reassessment
If symptoms persist beyond 6 weeks, initiation of Xolair (omalizumab) may be considered
Conclusion
This case illustrates the clinical presentation and management of dermatographic urticaria in an older female patient. At Village Dermatology in Katy and Houston, TX, we provide both immediate symptom relief with antihistamines and long-term strategies, including advanced therapies like Xolair, when needed.
