Dermatitis Herpetiformis

Definition

Dermatitis Herpetiformis (DH) is an important an autoimmune disease or complication of celiac disease which is manifested in the form of a skin rash.

Dermatitis herpetiformis was initially described over 100 years ago. Dermatitis herpetiformis usually begins in the twenties, though children may sometimes be affected. It is seen in both men and women.It is also known as Brocq-During disease, dermatitis multiformis, Duhring disease, and gluten-sensitive enteropathy.

Causes

The cause of DH is allergy to gluten, a protein found in wheat and some other grains. Usually allergies-hives, hay fever, and such-are made by the bodies IgE system. They can be treated with pills and shots.

Dermatitis herpetiformis usually begins in persons 20 and older, though children may sometimes be affected. It is seen in both men and women. Iodide and other halides may also cause a DH.

Symptoms

Symptoms of dermatitis herpetiformis tend to get worse and get better. The symptoms of dermatitis herpetiformis may resemble other skin conditions. DH looks like small clusters of red, itchy bumps. There are tiny water blisters, but these are quickly scratched off. Before they form, the area usually has a burning feeling. They scab and heal over one or two weeks, but new spots continue to appear. DH is a lifelong condition, but remission may occur in 10 to 20 percent of patients. Always consult your physician for a diagnosis.

In most cases, it is highly symmetric. Symptoms of dermatitis herpetiformis tend to wax and wane.

Treatment

Most patients with DH are symptom-free as far as the gastrointestinal tract is concerned; only 14 to 20 percent of patients with DH have malabsorption of fat, D-Xylose, or iron, or any combination as is typical of patients with GSE (celiac disease).

Pharmacologic treatment for dermatitis herpetiformis is dapsone. This medication has serious side effects and requires regular monitoring by your physician. When taken to relieve the symptoms of DH. Dapsone should be taken in the smallest effective doses for as short a time as possible. Medications for DH should not be used during pregnancy. Dapsone effectively controls skin findings and pruritus but may be associated with dose-related adverse effects such as hemolytic anemia, and idiopathic adverse effects such as neuropathy.

The diagnosis of DH is made by a simple skin test. A small piece of skin approximately 3 mms in diameter is taken from an unaffected area, ie. normal looking skin. The skin is examined for the presence of a substance called IgA (immunoglobulin A);and is found at a specific site in the skin.