FDA Approves First Drug for Dermographism Hives
People with chronic inducible urticaria develop itchy welts when a specific trigger, such as rubbing, cold air, or heat from exercise, stimulates the skin, according to a recent Dermatology Times roundtable.
How common are trigger-based hives?
Dr. Lindsey Finklea estimates that about 0.5% to 1.5% of the global population experiences hives that flare from a known stimulus. Roughly half of those patients have symptomatic dermographism, also called “skin writing,” where pressure or friction raises raised lesions.
The remaining cases involve cold-induced or exercise-related outbreaks. Many patients adjust daily routines to avoid exposure, which can mask the condition’s impact on quality of life.
First-line treatment and its limits
Non-drowsy antihistamines such as Zyrtec, Allegra and Xyzal are typically prescribed first. Dr. Finklea notes that standard doses achieve symptom control in only 20% to 50% of patients.
She recommends a gradual dose increase over two to three weeks and daily use, not just during flare-ups, after consulting a physician. Patients are advised to monitor symptoms closely during the titration period to gauge effectiveness.
New FDA-approved option for dermographism
In March, the FDA approved Rhapsido (remibrutinib) as the first medication specifically for adults with symptomatic dermographism who remain symptomatic despite antihistamines. The pill is not yet cleared for cold- or exercise-triggered hives, though data submissions are planned.
Read Also: Dermatologists Outline Year-Long Skin Plan for Brides
The phase 3 REMIND trial enrolled 115 adults who continued to break out on antihistamines. At week 12, 29% of participants receiving Rhapsido achieved a complete response, no hives on a standardized rub test, versus 14% on placebo.
Improvement was observed as early as week 2. Early improvement often encourages continued use of the therapy. Because a total absence of hives is a stringent endpoint, clinicians consider a minimal score on the rub test a realistic goal for many patients.
Common adverse events included nasopharyngitis, headache, nausea, abdominal discomfort and mild bleeding. The drug can cause petechiae, so physicians advise discussing bleeding risk before starting therapy. Rhapsido’s selective BTK inhibition makes it more targeted than earlier agents in the same class. Its mechanism targets the underlying immune pathways more precisely than older treatments.
Other biologic options such as omalizumab (Xolair) and dupilumab (Dupixent) remain in use, though no head-to-head trials compare them with Rhapsido. Choice depends on hive type, patient age, comorbidities and personal preferences.
Patients are encouraged to compile a detailed list of known triggers for their next dermatology visit, enabling a more tailored treatment plan.
