Dermographometer assessment in children with urticaria

Background Symptomatic dermographism (SD) is the most common subtype of chronic inducible urticaria, yet its prevalence and clinical relevance in pediatric urticaria remain incompletely characterized. Objective assessment of SD and its relationship with disease activity in children is limited. Methods In this prospective observational study, children aged 1–18 years with acute or chronic urticaria were enrolled at a tertiary care center. Dermographometer testing using FricTest® 4.0 was performed at baseline and repeated after 6 weeks. SD was defined as a wheal diameter ≥3 mm with pruritus at 10 min after provocation. Disease activity and control were assessed using the Urticaria Activity Score over 7 days (UAS7) and the Urticaria Control Test (UCT). Results A total of 144 children (median age 9 years; 49.3% male) were included, of whom 79.2% had chronic urticaria. SD was identified in 24.3% of patients, with similar prevalence between acute and chronic urticaria. Children with SD were older and more frequently reported skin stroking or scratching as a trigger (p < 0.001). Dermographometer wheal diameter correlated with UAS7 (r = 0.33, p < 0.001). Lower dermographometer thresholds and more positive FricTest pins were associated with greater disease activity. At 6-week follow-up, children with SD showed improved dermographometer responses but were less likely to achieve well-controlled disease. SD at presentation was more frequent among children who progressed to chronic urticaria. Conclusion SD is common in pediatric urticaria and is associated with higher disease activity and poorer short-term disease control. Dermographometer-based provocation testing may complement patient-reported outcome measures.