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 Russel 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.