IP Indian Journal of Clinical and Experimental Dermatology 2021;7(2):178–180 Content available at: https://www.ipinnovative.com/open-access-journals IP Indian Journal of Clinical and Experimental Dermatology Journal homepage: www.ijced.org/ Short Communication Skin writometer: A novel instrument for assessing provocation threshold in patients with symptomatic dermographism Kiran Godse 1, *, Gauri Godse 2 , Anant Patil 3 1 Dept. of Dermatology, DY Patil Deemed to be University, School of Medicine, Nerul, Navi Mumbai, Maharashtra, India 2 Shree Skin centre, Nerul, Navi Mumbai, Maharashtra, India 3 Dept of Pharmacology, DY Patil Deemed to be University, School of Medicine, Nerul, Navi Mumbai, Maharashtra, India ARTICLE INFO Article history: Received 18-03-2021 Accepted 20-04-2021 Available online 26-05-2021 Keywords: instrument Symptomatic dermographism Usefulness ABSTRACT Symptomatic dermographism, a type of physical urticaria is a common condition affecting patient’s quality of life. For its diagnosis, clinicians in India currently use tip of the ball point pen for estimating the provocation threshold. However, because of single tip of fixed length, ball point pen can-not differentiate between different grades of symptomatic dermographism. With variations in the intensity of stroke, there is a possibility of even missing the diagnosis. Hence, there is a need of a better method to diagnose symptomatic dermographism and determine the provocation threshold. Skin writometer, a plastic instrument with three arms of varying length can be novel in this regards. This instrument is simple, user friendly, easy to use and inexpensive. It can be used for diagnosis as well as assessment of treatment response in patients with symptomatic dermographism. © This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1. Introduction Physical urticaria is a diverse group of determinable conditions in which patients suffer from a chronic predisposition to develop localized or generalized urticaria upon contact with physical stimuli. Mechanical, thermal or electromagnetic stimuli can produce these responses. It accounts for nearly 20% to 30% of cases of chronic urticaria. 1 Dermatographism can be simple or symptomatic. 2 Simple dermatographism, a natural physiological response to physical stimuli is reported in about 1.5-5% healthy people. 1,2 On the other hand, symptomatic dermographism, can result in symptoms such as itching and burning due to wheal and flare response after slight pressure. 1,2 Symptomatic dermographism can impair the quality of life. 3,4 The severity of symptomatic dermographism differs among individuals. 3 * Corresponding author. E-mail address: drgodse@hotmail.com (K. Godse). 1.1. Current method for diagnosis of dermographism and its limitation Conventionally, the diagnosis is made by stroking the skin with a wooden tongue blade 2 or a ballpoint pen with an empty refill. 1 Use of ballpoint pen with empty refill is associated with some limitations in clinical practice. The length of the tip of ballpoint pen is fixed. Hence, the intensity of the stroke produced can be variable. Moreover, with traditional single stroke, there is chance of missing the diagnosis. 1 Estimation of provocation threshold i.e. the lowest level of shear force required to produce a positive wheal response is difficult with instruments with single tips/arms. The other methods to diagnose symptomatic dermographism include Dermographic tester, a spring-loaded dermographometer and Fric Test. 3 Dermographic tester also has only one tip 5 whereas Fric Test dermographometer is not available in India. 6 Considering the limitation of current method, a user friendly, simple but inexpensive method of eliciting https://doi.org/10.18231/j.ijced.2021.035 2581-4710/© 2021 Innovative Publication, All rights reserved. 178