Urticaria factitia L50.30

Urticaria factitia, as well as urticarial dermographism, often occur together with other forms of urticaria. They not infrequently persist after the "accompanying urticaria" has subsided and are then perceived as the only "disease symptom".

Provocation test by firmly scratching the skin on the back or forearm in the form of lines (preferably using a wooden spatula). This provokes various reactions, which can be differentiated according to latency time, duration and itching (see table). The rare intermediate and late types can be preceded by a typical immediate reaction. In cholinergic urticarial dermographism numerous pinhead-sized wheals appear in a striped arrangement instead of a line-like wheal. Familial and cold-dependent urticarial dermographism are also rare.

• In pronounced cases, the mast cell stabilizer ketotifen (e.g. zadites) shows good efficacy on wheals and itching. Initially 1 mg/day (once/day 1 Kps.) for 3-4 days, then increase to 2 times/day 1 mg and later to 2 times/day 2 mg p.o.
• Non-sedating antihistamines such as desloratadine (Aerius) 5-10 mg/day, cetirizine (Zyrtec) 10 mg/day, levocetirizine (Xusal) 5-10 mg/day can also be used.
• If necessary, use sedative medication at night: Hydroxycin (e.g. Atarax) 25-75 mg/day p.o. or Opipramol (e.g. Insidon) 50-150 mg/day p.o.
• In case of resistance to therapy, an experiment with a pseudoallergen-free diet (no preservatives, colorants or antioxidants) over 4-6 weeks should be carried out, see also Urticaria, chronic.

A defined exertion of pressure can be triggered with a standardized dermographometer, the tip of which can be used to trigger a pressure of 10-160g/qmm (HTZ Limited, Vulcan Way, New Addington UK).

1. Cap JP et al (1985) The effect of ketotifen in Urticaria factitia and Urticaria cholinergica in a crossed double-blind experiment. Dermatologist 36: 509-511
2. Butcher M, grave J (2004) Physical urticaria. dermatologist 55: 344-349
3. Kontou-Fili K et al (1997) Physical urticaria:classification and diagnostic guidelines. Allergy 552: 504-513
4. Juhlin L et al (1987) Inhibiting effect of cetirizine on histamine-induced and 48/80-induced wheals and flares, experimental dermographism and cold-induced urticaria. J Allergy Clin Immunol 80: 599-602
5. Termeer C et al (2015) Chronic spontaneous urticaria- A treatment path for diagnosis and therapy in the practice. JDDG 13: 419-429