{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:56:22Z","timestamp":1791446182111,"version":"4.3.3"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Dermatology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Physical urticaria is a subtype of chronic inducible urticaria characterized by wheals and\/or angioedema triggered by physical stimuli. We report a refractory case of combined localized heat urticaria, delayed solar urticaria, and symptomatic dermographism in a 16\u2010year\u2010old girl. Provocation testing showed erythematous and edematous lesions after thermal stimulation at 42\u00b0C and after the application of warm water at 40\u00b0C and 42\u00b0C. An intradermal test using the patient's serum heated to 42\u00b0C for 5\u2009min yielded a positive result, leading to the diagnosis of localized heat urticaria. Visible light irradiation induced no immediate wheals; however, wheals developed at all irradiated sites 4.5\u2009h later, accompanied by intense pruritus without burning sensation or pain, consistent with delayed solar urticaria. A FricTest provoked wheals, confirming symptomatic dermographism. Antihistamines were ineffective, and omalizumab, administered as a second\u2010line treatment, improved only the symptomatic dermographism, with no effect on the heat or solar urticaria. Dupilumab was subsequently administered 12 times. Repeated provocation testing during treatment showed resolution of symptomatic dermographism, whereas localized heat urticaria persisted and delayed solar urticaria showed no meaningful improvement. The Urticaria Control Test score also did not improve. These findings suggest that the pathogenesis of symptomatic dermographism in this case may involve IgE\u2010 and IL\u20104\/IL\u201013\u2010mediated pathways, whereas localized heat urticaria and delayed solar urticaria may be driven by distinct mechanisms.<\/jats:p>","DOI":"10.1111\/1346-8138.70423","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:04:23Z","timestamp":1784865863000},"page":"1525-1528","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Differential Effects of Dupilumab in a Patient With Localized Heat Urticaria, Delayed Solar Urticaria, and Symptomatic Dermographism"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-4735","authenticated-orcid":false,"given":"Shuta","family":"Yoshitani","sequence":"first","affiliation":[{"name":"Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine Osaka Medical and Pharmaceutical University  Takatsuki Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0803-9455","authenticated-orcid":false,"given":"Shinichi","family":"Moriwaki","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine Osaka Medical and Pharmaceutical University  Takatsuki Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2026-8154","authenticated-orcid":false,"given":"Atsushi","family":"Fukunaga","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine Osaka Medical and Pharmaceutical University  Takatsuki Osaka 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