Cortisol has a reputation of being a bad hormone released by stress. The thing is, it’s actually good to have a certain amount of it in your blood stream because it’s anti-inflammatory. Cortisol, secreted by the adrenal glands, prevents the release of substances in the body that cause inflammation. Histamine (an inflammatory) is the cause of dermatographic welts. If the adrenal glands aren’t functioning properly due to adrenal fatigue, then they won’t release enough cortisol and there will be a higher release of histamine–meaning more itchiness and welts.

One way to make sure your body is releasing enough cortisol and reducing histamine is to support your adrenal glands. By eliminating foods and substances that cause allergic and sensitivity reactions, you ease the stress put on your system. Food allergens can interfere with daily functioning and become a profound stress on your adrenals, so it is important to track down and eliminate these food sensitivities and allergies in order to both decrease your allergy load and promote adrenal health. One way to do this is with the elimination diet. I have yet to try it, but basically you do a two to four week cleanse and then slowly reintroduce foods one at a time to see which generate a reaction. Once the body is cleansed, the allergic reactions from certain foods are more noticeable, especially since you’re isolating each food. You could be slightly allergic to eggs or wheat or nuts and have no idea until doing the elimination diet. I have long thought that my dermatographia is exacerbated by certain foods, and so eliminated gluten from my diet. I definitely notice a huge improvement, but would like to know if there’s something else that is contributing to my symptoms. The next step for me is the elimination diet!

I researched the cortisol-histamine link further after meeting Henry on Skin Tome. He told me about his theory that the two are linked, and we started talking about dermatographia. Here’s the comment Henry wrote on a Skin Tome post, and what got us talking:

Hello Ariana, what happens is I start to feel like I need to itch – it is very difficult to NOT itch – and it ‘feels like’ it’s driven internally. My own theory is this: something in me makes my body release histamine at least to a level that makes me want to itch. Then I itch and this is where my dermatographia shows up. I don’t know if the “histamine release” and my dermatographia are related but my theory is this is the cause and effect. Now – why my histamine levels go up: well, my theory is that we all have some kind of 24 hour circadian rhythm. I think at night our systems normally release cortisol – well, my system is not secreting ENOUGH cortisol to suppress histamine (my theory). And/or my system is kicking in too much histamine, and I know that this is related somehow to the structure/number of “mast cells”. Anyway “I feel an overwhelming need to itch – and this drives the dermatographic wheals” – in fact, my sense is that itching helps ‘release’ the need to itch.

I asked Henry a bit more about his condition and experience. Here’s what we came up with:

Ariana Page Russell (APR): Can you please tell me a little bit about yourself? Where you live, what you do, etc.?

Henry Perretta (HP): I live in Alexandria, VA. I’m an independent health information technology consultant/contractor. I actually just sent you a Linked In invite to include you in my network. I have 2 sons – one is senior in college in MA; the other works in WI.

(APR): When and how did you find out you have dermatographia?

(HP): Goes back to 1993 (I think) – I originally thought it was a reaction to something I ate. Initially my doctor put me on the drug “Seldane” – then in the late ‘90’s he moved me to “Hydroxyzine”. I usually take one 25mg pill of Hydroxyzine a night. The issue with this drug is that it can cause you to get quite drowsy – not always – but when it does make me drowsy it’s pretty hard to stay awake.

(APR): What are your symptoms?

(HP): I feel a need to itch- lately (past year) that itch starts on upper part of one of my arms – but then progresses throughout my body. If I’m having an ‘attack’ – usually it occurs at night. I feel the need to itch – and the itching causes the dermatographia. The Hydroxyzine does not necessarily prevent the itching – in fact, I can say that NOT taking the Hydroxyzine will definitely leave me prone to an attack if I stay off the drug more than say 2 days. The symptoms are pretty much like the photo’s – raised “wheals” or “hive like” lines where I scratch during an attack. A complete attack goes away after about an hour or so. Sometimes the attack is limited to my arms; but sometimes it will progress over my entire body.

(APR): What’s your theory on why you have dermatographia?

(HP): I believe it has to do with the level of cortisol in my bloodstream – I believe that this level naturally drops in night time – but that my level drops too low – allowing histamine level to increase – driving itching. I also wonder if the membrane thickness of my mast cells are too thin – allowing easy release of histamine. Sometimes (not often) I will get an attack during the day- and if I do – this almost always means I’ll get one that night — this is one reason I personally believe that there is some circadian rhythm mechanism going on that is off kilt in my body where (for example) perhaps my cortisol level is too low — no one has ever proven that – it’s just a theory.

(APR): Do most people know you have it, or do you keep it to yourself? What do people think about it?

(HP): I am quite open with folks that I have it. They are generally sympathetic, but there’s not much they can do. I’ve even posted that I have it on Facebook. No one has ever responded to any Facebook posts I’ve made on this topic (not that I’ve made a lot).

(APR): How does it make you feel to have this condition? Embarrassed, indifferent, proud, annoyed, etc.?

(HP): It’s a pain in the ass; and can be quite debilitating. So yes – annoyed. I find it annoying because an attack is very ‘itchy’ and uncomfortable – to the point where I cannot sleep or work. In extreme cases, the experience is downright debilitating (I probably go through ½ dozen or so major attacks a year – and probably average about 15 or so attacks a month).

(APR): Is there anything else you’d like to know about dermatographia?

(HP): Any tests which could support/disprove my theory above.

(APR): Thanks Henry! I’m wondering, have you ever had thought that maybe you have adrenal fatigue? It’d be interesting to find out if there’s a link.

All photos courtesy of Henry Perretta