Clinical Factors Associated with Disease Severity in Symptomatic Dermographism: A Cross-Sectional Study

Background and Objectives: Symptomatic dermographism (SD) is the most common type of physical urticaria; however, data on its clinical characteristics and factors associated with disease severity remain limited. This study aimed to evaluate clinical features, triggering factors, associated conditions, and factors associated with disease severity in patients with SD. Materials and Methods: This cross-sectional study included 174 patients followed at a tertiary dermatology center. Data were collected using a structured questionnaire. Disease severity was categorized as severe versus non-severe using a non-validated, patient-reported classification. Factors associated with severe disease were analyzed using univariate and multivariable logistic regression models. Results: The median age was 33.0 years (IQR 27.0-40.2), and 57.4% of patients were female. Severe disease was present in 36.8% of cases. In multivariable analysis, male sex was independently associated with lower odds of severe disease (adjusted OR 0.40, 95% CI 0.20-0.82; p = 0.01). Angioedema and psychological stress were associated with disease severity in univariate analyses but not after adjustment. Persistent symptoms were more frequently reported among patients with severe disease. Conclusions: Male sex was associated with lower disease severity in this cohort. However, given the cross-sectional design and the use of a non-validated severity assessment, these findings should be interpreted as exploratory and hypothesis-generating, and do not support clinical risk stratification or causal inference.