Wednesday, January 5, 2011

Dermographism

Dermographism term literally means writing on the skin. Drawing the lines on the skin firm with a blunt object initially produces red line (capillary dilatation) followed by an extensive swelling with erythema (arteriolar dilatation) and formation of linear edema (fluid transudarea) called the answer Lewis's triple. An exaggerated response to this trend of swelling is observed in approximately 2-5% of the population and is called dermographism. La o minoritate dintre persoane este acompaniata de prurit (dermografism simptomatic) . In a minority of people is accompanied by itching (symptomatic dermographism).

Dermografismul este cea mai comuna forma de urticarie fizica si poate apare alaturi de alte forme de urticarie. Dermographism is the most common form of physical urticaria and can occur with other forms of urticaria. Incidenta crescuta a fost raportata in sarcina, mai ales in semestrul al doilea, la debutul menopauzei, la copii atopici si la pacientii cu boala Bechcet. The increased incidence was reported in pregnancy, especially in the second quarter, the onset of menopause, children and patients with atopic disease Bechcet.
Dermografismul simplu este cea mai comuna varianta iar pacientii cu aceasta forma sunt asimptomatici. Simple dermographism is the most common variant and patients with this form are asymptomatic. Totusi alte forme sunt asociate cu prurit afectind semnificativ calitatea vietii pacientului. Still other forms are associated with pruritus significantly affect patient quality of life. Cei mai multi pacienti cu dermografism sunt sanatosi. Most patients with dermographism are healthy. Sa descris o asociere cu boala tiroidiana la unii pacienti dar inca controversata. He described an association with thyroid disease in some patients but still controversial.

Pacientii cu dermografism simplu sunt asimptomatici si nu necesita terapie . Patients with simple dermographism are asymptomatic and require no therapy. Recunoasterea problemei, evitarea factorilor fizici precipitanti sunt metode importante in terapia medicala. Recognizing the problem, avoidance of precipitating physical factors are important methods in medical therapy. La persoanele simptomatice se folosesc antihistaminicele H1 ca agenti preferati. In symptomatic individuals H1 antihistamines are used as preferred agents. S-au mai folosit cu succes si f ototerapia cu UV-B alaturi de psoralen. We have successfully used f ototerapia with psoralen with UV-B.
Istoricul natural al dermografismului simptomatic este impredictibil. Natural history of symptomatic dermographism is unpredictable. Poate dura luni sau ani, sau poate fi prezent intermitent. It can take months or years, or may be present intermittently. La multi pacienti conditia se amelioreaza dradat si se vindeca dupa citiva ani. In many patients the condition is relieved dradat and heal after a few years. Dermografismul simptomatic pare a avea cea mai buna evolutie dintre toate urticariile cronice cu vindecare la 5 ani de 36% si la 10 ani de 51%. Symptomatic dermographism seems to have the best evolution of all-heal chronic urticaria 5 years 10 years 36% and 51%.

Patogenia si cauzele dermografismului Pathogenesis and causes dermographism

Mecanismul exact al dermografismului ramine incert. The exact mechanism of dermographism remains uncertain. Trauma poate elibera un antigen care sa interactioneze cu imunoglobulina E a mastocitelor care va elibera mediatori ai inflamatiei, in particular histamina in tesuturi. Trauma may release an antigen that interact with immunoglobulin E mast cells release mediators of inflammation will, in particular histamine in tissues. Aceasta determina vasodilatatia vaselor mici permitind fluidului sa se acumuleze in piele. This causes vasodilation of small vessels allowing fluid to accumulate in the skin. Alti mediatori posibil implicati sunt leucotrienele, heparina, bradikinina, kalikreina si substanta P. Other mediators possibly involved are leukotrienes, heparin, bradykinin, kallikrein, and substance P.

Dermografismul simptomatic poate fi declansat de medicamente : penicilina, muscatura de insecte, Helicobacter pylori sau o infestare : scabia , Fasciola hepatica. Symptomatic dermographism may be triggered by medications: penicillin, insect bite, Helicobacter pylori or infestations: scabies , Fasciola hepatica. Dermografismul simptomatic congenital a fost descris ca primul semn al mastocitozei sistemice . Congenital symptomatic dermographism has been described as the first sign of systemic mastocytosis. Aproximativ 75% dintre pacientii cu sindrom hipereozinofilic, care prezinta implicare multisistemica si mortalitate ridicata au dermografism. Approximately 75% of patients with hypereosinophilic syndrome, which shows the multisystem involvement and high mortality have dermographism. Factorii psihologici si un istoric de stress au fost implicate ca factori declansatori la 30% dintre pacienti. Psychological factors and a history of stress have been implicated as triggers in 30% of patients.

Semne si simptome Signs and symptoms

Dermografismul poate apare la persoane de orice virsta dar este mai frecvent la adultii tineri. Dermographism may occur in people of any age but is most common in young adults. Maximul de incidenta este in decada a doua si a treia de viata. The peak incidence is in the second and third decade of life. Tumefierea se dezvolta de obicei la 5-10 minute de la atingerea pielii si persista pentru 15-30 de minute. Se pot dezvolta edeme gigantice daca dermografismul este profund. Swelling usually develop 5-10 minutes after touching the skin and persists for 15-30 minutes. Dermographism may develop if edema is deeply giant.
Formele intermediare si tardive ale dermografismului sunt de asemeni descrise. Intermediate and late forms of dermographism are also described. Acestea se dezvolta mai lent si pot tine citeva ore pina la zile. They develop slowly and may take several hours to days. La pacientii cu dermografism simptomatic eruptia pielii este asociata cu prurit care este mai sever noaptea. Simptomele pot fi agravate de caldura-bai calde, presiunea minora (frecarea, scarpinarea sau stergerea cu prosopul, exerciti, stress si emotii. In patients with symptomatic dermographism is associated with itching skin rash that is most severe at night. Symptoms can be aggravated by heat, warm baths, minor pressure (rubbing, scratching or wiping with a towel, exercise, stress and emotions.

Examen fizic in dermografism Physical exam dermographism
Pruritul si edemul poate afecta toate suprafetele corpului, dar scalpul si zona genitala sunt mai rar implicate . Itching and swelling can affect all body surfaces, but the scalp and genitals are rarely involved. A fost raportata vulvodiia si dispareunia la pacientele cu dermografism simptomatic. It was reported vulvodiia and dyspareunia in patients with symptomatic dermographism.

Formele rare de dermatografism includ urmatoarele: Dermatografism rare forms include the following:
-dermografismul rosu- frecarea repetata induce aparitia de papule mici, punctate mai proeminente pe trunchi decit pe membre, este asociata cu dermatita seboreica Red dermographism repeated friction-induced appearance of small papules, scored more prominent on the trunk than the limbs, is associated with seborrheic dermatitis
-dermografismul folicular -se caracterizeaza de papule urticariene, discrete, tranzitorii, foliculare care apar pe un fond eritematos Follicular dermographism-hives, is characterized by discrete, transient, occurring against a background of follicular erythematosus
-dermografismul colinergic este caracterizat de aparitia unei linii edemetoase punctate eritematoase similara cu urticaria colinergica -Cholinergic dermographism is characterized by the appearance of a dotted line edemetoase similar erythematous urticaria Cholinergic
-dermografismul tardiv-l a 3-8 ore dupa raspunsul dermografic imediat apare in acelasi loc un edem profund, pruriginos care persista pentru 48 de ore; aceasta forma este recalcitranta la terapia conventionala si este asociata cu urticaria presionala Late-L-dermographism 3-8 hours immediately after the answer is demography in the same place a deep swelling, itching that lasts for 48 hours, this form is recalcitrant to conventional therapy and is associated with urticaria-loaded
-dermografismul precipitat de frig Cold-precipitated dermographism
-dermografismul indus de exercitii Exercise-induced dermographism
-dermografismul familial cu model autosomal dominant. Dermographism family with autosomal-dominant model.

Dermografismul simplu este cea mai comuna varianta iar pacientii cu aceasta forma sunt asimptomatici. Simple dermographism is the most common variant and patients with this form are asymptomatic. Totusi alte forme sunt asociate cu prurit afectind semnificativ calitatea vietii pacientului. Still other forms are associated with pruritus significantly affect patient quality of life. Cei mai multi pacienti cu dermografism sunt sanatosi. Most patients with dermographism are healthy. Sa descris o asociare cu boala tiroidiana la unii pacienti dar inca controversata. He described an association with thyroid disease in some patients but still controversial.

Diagnosticul de dermografism The diagnosis of dermographism
Studii de laborator: Laboratory studies:
-rezultatele testelor hematologice si biochimice sunt normale -Blood and biochemical test results are normal
-la unii pacienti nivelul sanguin de histamina este ridicat dupa frecarea experimentala. -In some patients is elevated blood levels of histamine after friction experiments.
Diagnosticul diferential se face cu urmatoarele afectiuni: mastocitoza, urticaria cronica, urticaria pigmentosa, dermografismul alb, negru si galben. The differential diagnosis is made with the following conditions: mastocytosis, chronic urticaria, urticaria pigmentosa, white dermographism, black and yellow.

Tratament Treatment

Pacientii cu dermografism simplu sunt asimptomatici si nu necesita terapie. Patients with simple dermographism are asymptomatic and require no therapy. Recunoasterea problemei, evitarea factorilor fizici precipitanti, reducerea stressului si a anxietatii sunt metode importante medicale. Recognizing the problem, avoidance of precipitating physical factors, reducing stress and anxiety are important medical methods. De asemeni scarpinatul pielii uscate poate fi redus prin aplicarea de emoliente. Also scratching dry skin can be reduced by application of emollients.

Antihistaminicele H1 sunt agentii preferati. H1 antihistamines are the preferred agents. Exemple: cetirizine, loratadine, desloratadine, acrivastine, fexofenadine, hidroxizine. La unii pacienti pot fi necesare mai multe antihistaminice sau o combinatie. Examples: cetirizine, loratadine, desloratadine, acrivastine, fexofenadine, hydroxyzine. Some patients may take several antihistamines or a combination. Antihistaminele sedative cum este hidroxizina este eficienta. Sedating antihistamines such as hydroxyzine is effective. Tratamentul regulat poate fi necesar pentru citeva luni. Regular treatment may be necessary for several months. adaugarea de antagonisti ai receptorului H2 pare a avea un raspuns simptomatic slab, desi unele studii au aratat reducerea edemelor. addition of H2-receptor antagonists seems to have a poor symptomatic response, although some studies have shown to reduce edema. Urticaria fizica este de obicei neresponsiva la corticosteroizii sistemici. Physical urticaria is usually unresponsive to systemic corticosteroids.

Fototerapia cu UV-B de banda scurta si psoralen oral prul UV-A au fost folosite ca tratamente pentru dermografismul simptomatic. Phototherapy with UV-B band and short hair oral psoralen UV-A were used as treatments for symptomatic dermographism. Ameliorarea subiectiva a pruritului si edemelor si reducerea obiectiva a edemelor sunt aparente. Subjective improvement in pruritus and edema and reducing edema are apparent objective. Totusi ameliorarea este de scurta durata iar cei mai multi pacienti au recaderi in 2-3 luni de la terminarea fototerapiei. But improvement is short lived and most patients relapse within 2-3 months after phototherapy.

Prognostic Prognosis

Istoricul natural al dermografismului simptomatic este impredictibil. Natural history of symptomatic dermographism is unpredictable. Poate dura luni sau ani, sau poate fi prezent intermitent. It can take months or years, or may be present intermittently. La multi pacienti conditia se amelioreaza dradat si se vindeca dupa citiva ani. In many patients the condition is relieved dradat and heal after a few years. Dermografismul simptomatic pare a avea cea mai buna evolutie dintre toate urticariile cronice cu vindecare la 5 ani de 36% si la 10 ani de 51%. Symptomatic dermographism seems to have the best evolution of all-heal chronic urticaria 5 years 10 years 36% and 51%.

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