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Dermatitis Herpetiformis

Published on Sep 28, 2016 and last reviewed on Apr 18, 2019   -  2 min read

Abstract

Abstract

If a person taking wheat, barley and rye in diet and develops extensively itching symmetrical lesions over extensor aspect of the body, then we must think of this disease. Here, I have discussed the causes, presentation and treatment of dermatitis herpetiformis.

Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is characterized by an intensely itchy, chronic, papulovesicular eruption that is usually distributed symmetrically on the extensor surfaces. The prevalence varies from 10 to 39 per 100,000 persons. Although more common in the second, third or fourth decades, DH may start at any age. After its presentation, DH persists indefinitely in varying severity.

Gluten is a protein found in wheat, barley and rye, which plays a critical role in the pathogenesis of DH. IgA antibodies formed against this protein in the predisposed individuals are thought to cross-react with certain antigens of the dermal-epidermal junction leading to clinical expression of the disease. It is probable that most patients with DH have some degree of gastrointestinal abnormality similar to that seen in celiac disease.

Clinical Presentation:

The primary lesion of dermatitis herpetiformis is either an erythematous papule such as an urticaria-like plaque or most commonly a vesicle. Large bulla is infrequent. The lesions are usually extremely itchy and located symmetrically on the elbows, knees, shoulders, lower back and buttocks. The face and facial hairline may be involved.

Associated Problems in DH:

In Gastrointestinal Tract:

Malignancy:

There is an increased frequency of gastrointestinal lymphomas and non-Hodgkin’s lymphoma in DH patients.

Other diseases

These patients also have a high incidence of autoimmune diseases such as,

  1. Insulin-dependent diabetes mellitus.
  2. Autoimmune thyroid disease.
  3. Pernicious anemia.
  4. Addison's disease.
  5. Lupus erythematosus.
  6. Vitiligo.
  7. Myasthenia gravis (weakness of voluntary muscles).
  8. Scleroderma (chronic hardening and tightening of the connective tissues and skin).
  9. Sarcoidosis.

Treatment

1. Dapsone:

It is the drug of choice for DH in the usual dose of 100 to 150 mg per day. Occasionally, patients will require double this dose. There is a prompt relief of symptoms and no new lesions erupt after one to two days of therapy. However, the patients have to be maintained on a minimal dose of Dapsone (sometimes as little as 25 mg on alternate days), because the disease activity increases sharply on cessation of treatment.

2. Sulfapyridine:

It is useful for patients who cannot tolerate Dapsone in a dose of 1 g to 1.5 g per day.

3. Gluten-free diet:

Thus, do not take itching lightly, as it is a very common symptom of most of the skin diseases.

 

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Last reviewed at:
18 Apr 2019  -  2 min read

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Dr. Suvash Sahu

Dr. Suvash Sahu

MBBS, DNB (DERMATOLOGY,LEPROLOGY& VENEREOLOGY)

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