We read with great interest the study by Kıraç et al. examining the associations between FricTest® response levels and clinical assessment tools in symptomatic dermographism.1 Their work contributes to a practical effort to quantify disease activity and patient-reported burden using a tool with potential for broad clinical utility. The authors’ findings demonstrated a moderate correlation between changes in the 4.5 mm and 4 mm FricTest® responses and validated scales, such as the urticaria control test (UCT), urticaria activity score (UAS), and dermatology life quality index (DLQI), suggesting that higher-intensity wheal reactivity may be more clinically informative.

However, key aspects of the statistical approach may limit the confidence in the strength and applicability of these associations. The analysis relied on Spearman correlation coefficients but did not report confidence intervals, which restricts the interpretability of the observed effect sizes. More importantly, correlation does not imply predictive capacity. Without regression modeling to adjust for baseline disease severity or demographic covariates, it remains unclear whether changes in FricTest® values are independently associated with treatment response or simply reflect regression to the mean. This limitation is not merely a technical issue. In a clinical setting, dermatologists must decide whether repeating the FricTest® meaningfully informs therapeutic adjustments or patient counseling. Without understanding its added predictive value over conventional scales (e.g., UCT), the test’s standalone contribution remains unclear.

Furthermore, the lack of correlation between FricTest® changes and visual analog scale (VAS) scores for itch and burning raises questions about the pathophysiological specificity of this measurement. If the test reflects mechanical wheel responsiveness but not subjective symptom severity, its role may be limited to diagnostic rather than longitudinal monitoring contexts.2,3 This disconnect merits closer evaluation, particularly as symptomatic dermographism is fundamentally a patient-experienced condition.

Despite these concerns, this study adds value by suggesting that lower-pressure stimuli (3.5 and 3 mm) do not correlate well with validated scales. This narrows the clinically useful thresholds and may help streamline test administration protocols. This also reinforces the fact that excessive granularity in provocation testing may introduce statistical noise without clinical gain.

We commend the authors for integrating disease-specific and quality-of-life instruments in a unified analysis and for contributing data on a relatively under-investigated diagnostic tool. Future research should focus on validating these findings through multivariable models and exploring whether FricTest® changes the forecast of relapse or remission when used alongside standard scales.