Sir,I read the recent publication on using ballpoint pen as diagnostic tool with a great interest. Godse proposed “use of a ballpoint” pen as a simple instrument in the diagnosis of dermographism and delayed physical urticaria.[1] I accept and applaud this new idea. However, there are many concerns. First, as Godes proposed, “pressure of hand is a variable”[1] in this test and “gradual increase of pressure by hand is useful to detect mild, moderate or severe dermographism.”[1] The problem is whether this means no standardization. How to set a standard practice guideline in using ballpoint pen as a diagnostic tool is the next question to answer. In addition, a complete assessment on the diagnostic property (sensitivity, specificity and predictive value) of this new approach has to be done. Finally, although it is rare, it should also be kept in mind that the ballpoint pen can also induce allergic reaction and this might be a problem.[2]