Q: When I was 13 I was diagnosed with dermographism. When I turned 15 I developed folliculitis, a skin infection. I was sent to the allergist for the diagnosis. Since I developed this rash I have been having rashes and breakouts similar to folliculitis almost every time I shave my legs. It mostly forms from my knee down to my ankle. I develop tiny pimple-like bumps on my legs that itch and I stop shaving for about a week, they go away for the most part. But, it doesn’t happen every time I shave. Sometimes my legs just itch and I don’t develop the tiny pimple bumps. I have tried different lotions, razors and shaving creams. It also tends to be worse in the winter than in the summer, perhaps because my skin gets dryer in the winter. Also, I wake up in the middle of the night scratching my legs for sometimes up to an hour. I scratch them so much that I have scars from scratching. I am perplexed as to what to do next. I just want my normal non-itchy legs back. If I am allergic to shaving or a product that I’m using, why doesn’t it affect the rest of my legs but only the lower half?

A: Let’s begin by clarifying the diagnoses you have received over the years. Dermographism (often referred to as skin writing) is a form of hives known as physical urticaria. Also referred to as skin writing, it occurs in approximately five percent of the population. If an individual scratches his skin or if a collar or shirt cuff rubs against the skin, hives will appear within minutes. A dermographism hive differs from regular hives in that the rash will appear in a straight line if the scratch is straight. If it is curved or in a circle, the hive will be in a circle. Either way, it will disappear within a few hours. The condition commonly waxes and wanes, appearing for a period of time and not in others.

Diagnosis is made by the appearance of the rash. The health care worker determining the diagnosis may rub a tongue depressor or object across the skin. If hives appear and conform with the direction of the contact with the skin made by the object, the diagnosis is dermographism. When the hives appear frequently, an over-the-counter antihistamine often is recommended. If the skin is not so sensitive, no treatment may be provided at all.

Folliculitis occurs when hair follicles become infected with fungi, staph or other bacteria. The condition also has another name that mimics your problem and is referred to as barber’s itch. The infection is a series of small pimples around the hair follicles. Symptoms may include blisters that are filled with pus, extreme itching, bumps that are filled with pus, and red/inflamed areas of skin. There are several forms of folliculitis, including a staph form, one acquired in a hot tub, barbae that presents on the face of men where they shave, and pityrosporum which is caused by a yeast and appears on the neck, arms, face, back and chest.

Mild folliculitis generally disappears on its own in about two weeks. Because of your repeat bouts, I recommend you speak with your physician regarding possibly using an anti-fungal cream or pills, or taking a course of antibiotics. Another option or perhaps in conjunction with a prescription is hair removal through laser treatments. Laser will destroy the hair follicles so they cannot get infected. As difficult as it may be, you should avoid scratching, shower or bathe daily with an anti-bacterial soap, avoid using oils on your skin since they can trap bacteria in your pores that may trigger yet another attack, and avoid shaving over the bumps. If you don’t opt for laser therapy, ask your primary care physician or dermatologist about depilatory creams and lotions that will rid your legs of hair without shaving. There is also a possibility that you have razor bumps and may not necessarily be infected. Be sure to check that out with your health care professional.

Lastly, you are bothered by symptoms on your lower legs because the condition presents in areas where hair grows. You likely shave your legs once a week but like most females, don’t shave your upper legs, which is why you are having an exacerbation of problems there.