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Dermatitis Herpetiformis

What is dermatitis herpetiformis?

Dermatitis herpetiformis (DH) is an intensely pruritic (itchy) skin disease characterized by eruptions of clusters of small blisters or vesicles (small elevations of the skin containing fluid) and small bumps or papules (small, solid, elevations on the skin). Dermatitis herpetiformis usually occurs in young adults (age 20 and older). It affects more men than women, and is a life-long condition.

What triggers dermatitis herpetiformis?

The herpes virus does not cause DH, even though the name suggests that it does. Dermatitis herpetiformis is related to the presence of IgA deposits under the skin. These deposits occur in response to consuming glutens (proteins) in the diet, such as those found in wheat, barley, rye, and oat products. The disease is not common among African-Americans or Asians. Persons with dermatitis herpetiformis often have a high incidence of autoimmune disorders and thyroid disease.

There is no known way to prevent this disease. People who suffer from DH may be able to prevent complications by avoiding foods that contain gluten. Although this is very difficult to do, adherence to a gluten-free diet can reduce the amount of medications needed to manage the disease.

What are the symptoms of dermatitis herpetiformis?

The following are the most common symptoms of dermatitis herpetiformis. However, each individual may experience symptoms differently. Symptoms may include:

  • Clusters of itchy, small blisters, mostly on the elbows, lower back, buttocks, knees, and back of the head
  • Itching and burning are often severe

Individuals may also have some damage to their intestines. This is called gluten-sensitive enteropathy (GSE) or celiac disease. Some cases of GSE become cancerous. Because of this, if you have celiac disease, it is important to have an evaluation by a physician who specializes in the stomach and intestines (a gastroenterologist).

The symptoms of dermatitis herpetiformis may resemble other skin conditions. Always consult your physician for a diagnosis.

How is dermatitis herpetiformis diagnosed?

In addition to a medical history and physical examination, dermatitis herpetiformis is usually confirmed with a skin biopsy with immunofluorescence (a specialized type of stain which helps to detect the presence of IgA antibodies).

Treatment for dermatitis herpetiformis:

DH may be well-controlled with treatment. Specific treatment for dermatitis herpetiformis will be determined by your physician based on:

  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures, and therapies
  • Expectation for the course of the condition
  • Your opinion or preference

The symptoms of dermatitis herpetiformis may clear when all gluten is eliminated from the diet, although healing may take several weeks to months. Treatment may also include drug therapy. Dapsone, a medication which can improve symptoms by suppressing the skin response, may be prescribed. However, dapsone has been associated with some side effects, especially anemia. If Dapsone is prescribed for you, your physician will carefully monitor your blood count.

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