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Dermatitis Herpetiformis - Symptoms & Treatment


Dermatitis herpetiformis (DH) is an intensely itchy skin eruption. Dermatitis herpetiformis is linked to sensitivity of the intestine to gluten in the diet (celiac sprue). It is characterized by grouped excoriations; erythematous, urticarial plaques; and papules with vesicles. Dermatitis herpetiformis usually begins in persons 20 and older, though children may sometimes be affected. It is seen in both men and women. The typical features are small grouped itchy blisters, often on red plaques, situated on the back of the elbows and forearms, buttocks and front of the knees. Although these are the common sites the rash may in addition, occur anywhere on the body including face, scalp and trunk. It is caused by deposition of IgA in the papillary dermis. This triggers an immune cascade, including recruitment of neutrophils and complement into the area. DH was formerly described in the literature as Duhring's Disease. It has a typical onset in the teens or in the third or fourth decades of life. It usually occurs in association with an asymptomatic gluten-sensitive enteropathy (disease of the intestine, similar to that in celiac disease.

Dermatitis herpetiformis is much less common in black and Asian populations.  It is also known as Brocq-During disease, dermatitis multiformis, Duhring disease, and gluten-sensitive enteropathy. DH is a persistent condition and only approximately 10% of patients have a spontaneous permanent remission. It is a rare disease in the UK. Diagnosis of dermatitis herpetiformis usually requires at least one skin biopsy, and sometimes a blood test (looking for anti-gliadin, anti-reticulin and anti-endomysial antibodies). The person with dermatitis herpetiformis may not realize that they have major disturbance in their digestive tract but studies have shown similar if not identical disease processes. It appears as though the gene for celiac disease may ride on the same gene as diabetes, and like diabetes, anyone can carry the gene but not have the disease. People with dermatitis herpetiformis occasionally develop lymphoma in the intestines. Small blisters usually develop gradually, mostly on the elbows, knees, buttocks, lower back, and back of the head. Dermatitis herpetiformis can flare and subside even without treatment. Dapsone, an antibiotic, may help the majority of patients.

Causes of Dermatitis herpetiformis

The common causes and risk factor's of Dermatitis herpetiformis include the following:

  • Deposition of IgA in the papillary dermis.
  • Neurological conditions.
  • A bowel disorder known as coeliac disease.
  • Food allergies.
  • A family member with Dermatitis herpetiformis disease.

Symptoms of Dermatitis herpetiformis

Some sign and symptoms related to Dermatitis herpetiformis are as follows:
  • Intense itching is the first and main symptom.
  • Abdominal pain.
  • Excessive gas.
  • The bumps or blisters usually appear on the elbows, knees, back, and buttocks.
  • Blistering skin rash.
  • Pale, malodorous, bulky stools.
  • Discrete papules (bumps).

Treatment of Dermatitis herpetiformis

Here is list of the methods for treating Dermatitis herpetiformis:

  • A gluten-free diet  is the main form of treatment, and the most effective in the long term.
  • Dermatitis herpetiformis may also be treated with a drug called dapsone.
  • Colchicine is another treatment option.
  • Ultrapotent topical steroids.
  • If dapsone therapy causes considerable hemolysis, significant cardiopulmonary problems, or peripheral neuropathy, sulfapyridine may be used.
  • Systemic steroids may be a successful treatment option.

 

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