|Year : 1994 | Volume
| Issue : 5 | Page : 251-253
Ketotifen in the treatment of symptomatic dermographism
Jacob Daniel, C Balachandran, CR Srinivas
Source of Support: None, Conflict of Interest: None
The efficacy of ketotifen, a benzocyclo heptathiophene derivative was evaluated in 24 patients with symptomatic dermographism in a double-blind cross-over study. Dermographism was induced by a device at two different pressure before, during and after ketotifen treatment. Symptomatic improvement was seen during ketotifen therapy, but no benefit was observed with the placebo. However lesions recurred few days after stopping the treatment.
Keywords: Ketotifen, Symptomatic dermographism
|How to cite this article:|
Daniel J, Balachandran C, Srinivas C R. Ketotifen in the treatment of symptomatic dermographism. Indian J Dermatol Venereol Leprol 1994;60:251-3
|How to cite this URL:|
Daniel J, Balachandran C, Srinivas C R. Ketotifen in the treatment of symptomatic dermographism. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2020 Nov 24];60:251-3. Available from: https://www.ijdvl.com/text.asp?1994/60/5/251/4069
| Introduction|| |
Dermographism is an abnormal wealing response of the skin to moderate local trauma  Symptomatic dermographism refers to dermographism accompained by pruritus  Classic dermographism is the ability of the skin to produce a linear weal with a scratch pressure of 4900 gm/cm  A significant number of patients with symptomatic dermographism are benefited by antihistaminics, whereas other therapeutic measures have revealed only variable results 
Ketotifen ,, an antihitaminic with antianaphylactic , and calcium channel blocking properties  is known to prevent mast cell degranulation  and has been tried successfully in various mast cell mediated disorders. , However, there are remarkably few studies advocating ketotifen in symptomatic dermographism  We report a double-blind, placebo-controlled, randomized clinical trial designed to evaluate the efficacy of the drug in 24 patients with symptomatic dermographism.
| Materials and Methods|| |
24 patients, 13 male and 11 female with a history of symptomatic dermographism not on any medication for the last 2 weeks and those who could come for follow up on 2nd, 4th, Sth weeks were studied. A detailed history was obtained and patients having other coexistant diseases were excluded. Dermographism measuring 10 cm in length was induced medial to scapula on either side with a calibrated springed stylus at pressures of 2500 gm/cm 2 (Grade I) and 4900 gm/cm 2 (Grade II).
Assessment of the weal was made after 7 minutes by examining the erythema, size, induration and the presence of itching. The size of the weal was measured in millimeters and mean of the three sites were taken. Induration was palpated and graded as minimum, moderate and marked.
The drug containing 1 mg of ketotifen  colour and size matched placebo were coded by a third person. Patients at random received either the drug or the placebo two tablets twice daily. All patients were assessed as outlined earlier, during and after treatment at 2nd, 4th and 8th week of starting the drug or the placebo. If there was no improvement with the first drug after 2 weeks the patients received the other drug for another 2 weeks. However those patients who improved after the initial drug, received the same treatment for another 2 weeks. Decoding of the tablets were done at the end of the study and the results were statistically analysed.
| Results|| |
The maximun patients with symptomatic dermographism were in the age group between 21-31 years and it persisted for variable periods.
Placebo was received by a total of 13 patients. None of these showed clinical improvement. Mean size of the weal was increased by 0.08 mm, however in one patient itching had decreased.
Similary ketotifen was given randomly as the first drug to a total of 11 patients. 13 patients who failed to respond to placebo were subsequently administered ketotifen. Thus a total of 24 patients received the drug.
Dermographism induced at low pressure (Grade I) showed erythema in 19 patients only. It cleared in 7 cases (37%) during ketotifen treatment. The mean size of the weal was 3.25 mm. A reduction of 0.79 mm (24%) [P<0.05] was noted. Moderate to marked induration of the weal observed in 12 cases were reduced to minimum.
Dermographism elicited at high pressure (Grade II) showed erythema in 22 patients. It cleared in 9 cases (41%) during ketotifen therapy. The mean size of the weal was 4.25 mm. It was reduced by 1.365 mm (33%) [P<0.05). Moderate to marked induration of the weal obseved in 13 patients were reduced to minimun in 12 cases and no palpable weal was seen in one patient.
Itching completely subsided in 20 cases (85%) and the same clinical response was maintained during entire period of treatment. Adverse effects  of the therapy were unremarkable. Mild sedation and increased appetite were seen only in four patients during the initial days of treatment.
Follow up was done2-3 days after discontinuing the drug and after 4th week and 8th week. All patient showed reappearance of the symptoms except one.
| Comments|| |
Ketotifen, an orally administered mast cell stabilizing agent, is beneficial in patients with symptomatic dermographism ,, It is an H, receptor antagonist with antianaphylatic properties and also acts as phosphodiesterase inhibitor. Phosphodiesterase which degrads cAMP is inhibited there by increasing mast cell intracellular cAMP levels and preventing histamine release induced by IgE or chemical stimuli. In addition ketotifen has calcium channel blocking properties and inhibits the release of mixture of leucotrines known as slow releasing substances of anaphylaxis.
Our study showed marked clinical improvement, in all patients while they were taking the drug with minimal untoward effects, However loss of benefit became evident 2-3 days after stopping the drug. This shows that continuous medication is necessary. There are reports on its prolonged use  without any side effects. Other dermatological disorders where ketotifen is indicated are chronic idiopathic urticaria, physical urticaria, urticaria pigmentosa , bronchial asthma  and patients with food allergy.
Considering its beneficial effects in symptomatic dermographism with negligible adverse effects it may be used in this condition either alone or as an adjuvant along with other antihistamines.
| Acknowledgement|| |
Our sincere thanks to Messers SUN Pharmaceuticals who provided the drug.
| References|| |
|1.||Breathnach SM, Allen R, Ward M, et al. Symptomatic dermographism Natural history clinical features lab. investigation and response to therapy. Clinical Experimental Dermatology 1983; 8 : 463-76. |
|2.||Warin RP. Incidence of dermographism. Br Med J 1976; 2 : 298-305. [PUBMED] |
|3.||Sibbald G. Physcial urticaria. Dermotologic Clinics Vol 3, No 1, 1985; 60-8. |
|4.||Kennard C, Ellis CN. Pharmacologic therapy for urticaria. J Am Acad Dermatol 1991; 25 176-89. |
|5.||Martindale. The Extra Pharmacopoeia. 29th edition (Reynolds JEF) pharmaceutical press, London, 1989; 1422. |
|6.||Huston DP, Bressler R, Kaliner M, et al. Prevention of mast cell degranulation by ketotifen in patients with physical urticaria. An Int Med 1986; 104 : 507-10. |
|7.||Craps LP, Ney UM. Ketotifen current views on its mechanism of action and their therapeutic implication. Respiration 1984; 45 : 411-21. [PUBMED] |
|8.||Martin U, Romer D. Ketotifen A : new antianaphylatic agent. Allerg Immunopathol 1977;55. |
|9.||Martin U, Romer D, The pharmacological properties of a new, orally active antianaphylatic compound ketotifen, a benzocyclo heptathiophene. Drug Res 1978; 28 : 770-82. |
|10.||Radermecker M. Inhibition of allergen mediated histamine release from human cells by ketotifen and oxtomide. Respiration 1981; 41 : 45-55. [PUBMED] |
|11.||Czarnetzki BM. A double blind cross over study of the effect in urticaria pigmentosa. Dermatologica 1983; 166 : 44-7. [PUBMED] |
|12.||Shear NM Mcleod SM. Diffuse cutaneous mastocytosis (DCM) : treatment with ketotifen and cimetidine. Clin Invest Medi 1983; 6 : 3640. |
|13.||Naffen H, Subira MC. A study of the protective effect of ketotifen in food allergy. Allergol Immunopatho Madr 1980; 8 : 97-104. |
|14.||Craps LP. The prophylaxis of bronchial asthma with ketotifen : Five years of clinical investigation. Acta Therapeutic 1980; 6 : 113. |
|15.||Wong RC, Fairly JA, Ellis CN. Dermographism review. J Am Acad Dermatol 1984; 11 : 643-52. |
|16.||Goodman LS, Gilman AG. The pharmacological basis of therapeutics (Gilman AG, Rall TW, Nies AS, Taylor P, eds) 8th end, Singapore : Maxwell Macmillan inter edition 1990; 23 : 582-8. |
|17.||Kirby JD, Mathews CNA, james J, et al. The incidence and other aspects of factitious whealing. Br J Dermatol 1971; 85 : 331-5. |