A Classical Image of Dermographism

Abstract

Clinical ImageA 31year old male presented with complain of itching followed by localised swelling of the part that has been scratched. He also complained of swelling of parts of limb and back on being hold tightly, stroked or rubbed and intermittent swelling of lips. Symptom was worsened by abrasive and tight clothings. The patient had no history of respiratory symptoms suggestive of asthma. General survey and systemic examination was normal other than raised skin within minutes on scratching left arm with a pinhead suggestive of dermographism (Panel A-G). Routine blood count revealed haemoglobin 13 gm/dl, a leucocyte count of 8000/ cumm with increase in the percentage of eosinophils. The absolute eosinophil count was 880/cumm. Serum IgE level was 835 IU/ml. The patient was treated with albendazole (400 mg), levocetrizine (5 mg) for four weeks and with a H2 receptor antagonist with an advice to follow after one month. Figure 1: Demonstration of raised skin surface on left arm following scratch with a pin head (Panel A-G).