Dr. James Hamblin wrote this awesome article about Skin Tome and dermatographia in The Atlantic:

“They knew that their skin did something weird, but they didn’t know what it was.”

People who reach out to Ariana Page Russell, an artist in Brooklyn, often see their own skin in hers. Many have epidermal reactions like Russell’s, furrowing into palpable welts at the provocation of even a light scratch of the neck or rub of the eye.

“It’s fascinating the way people respond,” Russell told me. “People email me from all over. China, Colombia, Brazil, Turkey—I have a ton of people emailing me from Turkey.” For many who find her photography online, Russell says, a once alienating condition becomes a point of solidarity.

“They see the photos and say, ‘Hey, my skin does that, too.’ I didn’t know it was a thing with a name,” Russell said. “They feel better having a name for it, and knowing they’re not alone.”

That name is dermatographia urticaria, usually just called dermatographia or dermographism (literally “writing on the skin”). It’s a type of “trauma-induced urticaria,” but the trauma in this case can be almost nothing—basically an allergic reaction to minimal physical stimulation. Scratching, stroking, rubbing, or slapping the skin makes cells release inflammatory chemicals like histamine, and that results in fluid leakage from superficial blood vessels.

Of course, slap or scratch anyone and it will inflame their skin. In dermatographia the reaction is distinctly more severe. There is puffiness and extensive redness (in fair skin). Everyday things like wearing a belt or scratching an itch can make a person appear to have endured significant injury. If Russell scratches her face, it swells. “It looks like I have a black eye or something,” she said. “I have to be careful and not rub my eyes. I definitely have had people ask, ‘Whaaat happened to you!?’”

The reaction can also be brought on by cold weather, strong emotions, hot water, or exercise. The finding is usually incidental and requires no treatment, but some people with severe or especially itchy versions take antihistamines to minimize the allergic-type symptoms, which can then spread to parts of the skin that were not stimulated. Russell doesn’t take medication. Her treatment has consisted of owning her skin and turning the condition into something positive.

“Thank you for making what we have an art form and giving me a way to explain to people it’s perfectly normal and beautiful,” a reader from Belgium wrote to Russell recently. “I have lived with it for years trying to hide it and now I can say it’s my art.”

Russell realized that she had dermatographia in an understated fashion. “I just thought my skin was really sensitive, and then I started photographing the drawings and people were like, ‘What is this?’” Russell was in graduate school at the time and went to a University of Washington physician who gave her the diagnosis. “It was like, here you go, congratulations. Everything else I kind of learned on my own.”

Russell started taking the photos in 2003. She later began a website with some of her skin-writing photos and in 2008, without telling Russell, a friend submitted one of the images to a site called “It’s Nice That.” They published it, and her site “started going crazy.”

“And then I got this email with the subject line, ‘Hello from Kelsey at ABC News,’ and I thought, is this spam?” It wasn’t. It led to a 20/20 segment. Since then, she has become a modern face of the condition. Also the body and voice.

“I’ve become this unofficial expert on dermatographia since there’s not a whole lot out there about it. People will just write me and ask for my opinion on how they should treat it. Sometimes they send me photographs of their own skin, even without me asking them to, which I love receiving.”

“Some people write their name or my name on their arm,” Russell said. “Other people do elaborate drawings and have a friend photograph it.”

Those responses led Russell to start a site called Skin Tome, where she is forming a dermatographia community predicated on sharing and lack of shame. She is also collecting information about dermatographia to help those with the condition, about which there aren’t many mainstream resources. Most doctors have little to offer on the subject, and as diseases go, addressing it is usually a relatively low priority. But the effects can be insidious. Skin conditions also manifest well inside of the skin.

“Most of the people who write me are embarrassed by their skin, they feel shame and try to hide the condition from other people,” Russell said. She sees consequence in her work. “I’ve had people say they’re afraid to be intimate. I also get a lot of teenagers who reach out to me. It’s so hard to be a teenager anyway, especially if you’re ashamed of how you look.”

That’s typified by the story of Jes Blackwell, who keeps in touch with Russell over their shared skin sensitivities. Blackwell writes, “Being an awkward, dorky, queer outcast in high school in Wisconsin was enough of an ordeal that I had to live with, but every time I had a tiny little itch on my face and I wasn’t thinking… BLAM!! A gigantic welt would appear on my already hormonally confused face. Needless to say, I did not date.”

But it’s not entirely lament; there’s good in most of the confessionals. Blackwell goes on to write about being a child playing tic tac toe on her legs during long car rides, and leveraging her propensity for looking victimized to get her sister in trouble.

“A lot of people don’t know they have it, and I think my images have played a big part in spreading the word about it,” Russell said. They might think they have blotchy or irritable skin. They try scratching their skin, realize it’s a condition with a name and a community, and that is therapy.

“There’s this statistic out there that five percent of people have it,” Russell said. “But I think it might be more common than that.”

#SkinWriting is an active hashtag among people with dermatographia on Twitter; and the Facebook page, “I’m a Skin Writer, I Have Dermatographism,” which Likes Russell’s work, has an active community of over 2,400 people. Many post skin-writing photos. Their skin is a responsive, living canvas that ages and changes; a barrier to the world that’s also connection to it. They share art and stories and triggers and treatments. Russell, for one, feels like her symptoms have become less noticeable since improving her diet and general health. “I drink a ton of water, go easy on alcohol and sugar, and eat whole foods, lots of fruits and vegetables.”

“When I first started photographing my dermatographic drawings I thought nobody would be interested in them,” she wrote recently on her site, “or even worse, people would find them totally gross.”
Thank you for the great article Dr. Hamblin!