| Dermatitis herpetiformis (DH) is a skin disorder often | | | | gluten (a protein found in cereals) sensitivity in the small |
| associated with celiac disease. (DH) is an intensely | | | | bowel. This means that instead of being highly |
| itchy skin eruption. Dermatitis herpetiformis usually | | | | convoluted, the lining of the intestines is smooth and |
| begins in persons age 20 and older, although children | | | | flattened. Gluten is a protein present in grasses of the |
| may sometimes be affected. It is seen in both men | | | | species Triticeae, which includes barley, rye, and |
| and women. It usually shows up in young adults, and is | | | | wheat. Rice and oats belong to different species and |
| more common in men and people originally from some | | | | are generally well tolerated. Hormonal factors may |
| areas of northern Europe. It has been hypothesized | | | | also play a role in the pathogenesis of DH. Androgens |
| that DH is the result of an immunologic response to | | | | have a suppressive effect on immune activity, including |
| chronic stimulation of the gut mucosa by dietary gluten | | | | decreased autoimmunity, and androgen deficient |
| with subsequent activation of cutaneous endothelial | | | | states may be a potential trigger for DH exacerbation. |
| cells and circulating inflammatory cells, including | | | | IgA circulating immune complexes are present in |
| neutrophils. DH was formerly described in the literature | | | | 25-35% of patients with DH, although no association |
| as Duhring's Disease. Several chemicals have been | | | | with disease severity has been noted. These immune |
| associated with induction of DH, including potassium | | | | complexes also have been noted in patients with |
| iodide and cleaning solutions. It has a typical onset in the | | | | isolated GSE and are believed to be related to the |
| teens or in the third or fourth decades of life. In the U.S., | | | | presence of the gut disease. Associated autoimmune |
| the presence of diagnosed cases is estimated to be | | | | diseases include dermatomyositis, type 1 diabetes |
| about 1 in 10,000 with a male/female ratio of 2:1. It is | | | | mellitus, myasthenia gravis, rheumatoid arthritis, |
| more common in whites and rare in people of African | | | | Sjögren syndrome, systemic lupus |
| or Asian descent. If you have DH, you always have | | | | erythematosus, and thyroid abnormalities. Thyroid |
| gluten intolerance. With DH, the primary lesion is on the | | | | abnormalities are present in as many as 50% of DH |
| skin, whereas with celiac disease the lesions are in the | | | | patients and include hypothyroidism, hyperthyroidism, |
| small intestine. | | | | thyroid nodules, and thyroid cancer.Gastric manipulation |
| Symptoms of dermatitis herpetiformis are intense | | | | (surgery) may induce DH. |
| burning, stinging and itching around the elbows, knees, | | | | There is a very effective treatment available for |
| scalp, buttocks and back. More locations can also be | | | | dermatitis herpetiformis. A gluten-free diet is very |
| affected and the severity can vary. Scratching will | | | | difficult to achieve; however, limiting intake of wheat, |
| further irritate the eruptions. Eruptions commonly occur | | | | barley, or rye products can lessen the symptoms. |
| on pressure points, such as around the elbows, the | | | | Dapsone can be associated with severe hematologic |
| front of the knees, the buttocks, back face, and scalp | | | | (blood) disturbances and must be closely monitored. |
| but can appear anywhere on the body. Eruptions are | | | | However, strict long-term avoidance of dietary gluten |
| usually bilateral - occurring on both sides of the body. | | | | has been shown to reduce the dose of dapsone |
| Ingestion of gluten plays a role in the exacerbation of | | | | required to control the disease and may even eliminate |
| skin lesions. Small blisters usually develop gradually, | | | | the need for medication. In addition, a gluten-free diet |
| mostly on the elbows, knees, buttocks, lower back, and | | | | may reduce the risk of gastrointestinal lymphoma. |
| back of the head. Sometimes blisters break out on the | | | | Other, less effective treatments for DH include |
| face and neck. The rash may be small lumps, like | | | | colchicine, cyclosporine, azathioprine, and prednisone. |
| insect bites (papules), some with tiny fluid filled blisters | | | | UV light may provide some symptomatic relief. |
| on top. These small blisters are called vesicles. | | | | Cyclosporine should be used with caution in patients |
| However it can also appear hive-like, persisting in one | | | | with DH because of a potential increase in the risk of |
| area, or it may look like a pink and scaly dermatitis. The | | | | developing intestinal lymphomas. Nonsteroidal |
| fact that the rash is most prevalent at pressure points | | | | anti-inflammatory drugs may exacerbate DH; however, |
| (where clothing rubs the most) may be why the | | | | ibuprofen appears to be safe. Gulphapyridine or |
| symptoms sometimes appear to be symmetrical. | | | | sulphamethoxypyridazine have been used to suppress |
| Typically, the onset of DH is in the second to fourth | | | | the skin manifestation. It takes several months for the |
| decade; however, persons of any age may be | | | | skin to improve on these drugs and they do not |
| affected. | | | | protect against the serious complication of gluten |
| Dermatitis herpetiformis is frequently associated with | | | | hypersensitivity. |