9/16/2023 0 Comments Top of feet itchFor the case patient described above, symptomatic dermographism was diagnosed after stroking the skin with a smooth blunt object (the back of the fingernail) whealing occurred after one to two minutes and lasted for 20 minutes. Symptomatic dermographism should always be suspected when a patient complains of itch in the absence of abnormal skin, and the diagnosis is easily confirmed by scratching the skin. It often follows viral infections and allergic reactions and it is not uncommon after an episode of scabies. The itching is usually more intense than the skin changes suggest and is most severe at night. Patients typically complain of whealing and itching at sites of trauma or friction with clothing or after scratching the skin. It can occur at any age but the incidence is highest in children and young adults. The correct diagnosis is symptomatic dermographism, a subtype of inducible urticaria whereby a mechanical stimulus induces reproducible wheal-and-flare reactions with itching and burning sensation as a result of histamine release from cutaneous mast cells. However, lightly stroking the skin with the back surface of the examiner’s fingernail causes whealing (Figure). On examination, some excoriations and broken skin are noted on the boy’s flanks, arm and lower limbs. Three further treatments for the whole family, as well as contact tracing and treatment and management of fomites, have not made any difference to his symptoms. The boy’s mother says that the problem started after the child and the rest of the family were first treated for scabies. The itching is distracting him at school. She has changed her washing powder and the child has been placed on a dairy-free and gluten-free diet, but his symptoms have not improved. His mother says he gets red blotches on his skin that ‘come and go’ and that she has noticed that his nocturnal scratching has been severe enough to cause bleeding, as indicated by blood on his bed sheet in the morning. A 5-year-old boy presents with a history of constant scratching and complaints of itch.
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