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Dermatitis Herpetiformis - Definition, Causes, Symptoms and Treatment


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Dermatitis herpetiformis is a chronic inflammatory disease that produces lesions that burn and itch intensely. Dermatitis herpetiformis is related to the presence of IgA deposits under the skin. Dermatitis herpetiformis usually shows up in young adults, and is more common in men and people originally from some areas of northern Europe. It is characterized by eruptions of clusters of small blisters or vesicles and small bumps or papules. The symptoms are intense burning, stinging and itching around the elbows, knees, scalp, buttocks and back. More locations can also be affected and the severity can vary. Herpes virus does not cause dermatitis herpetiformis, even though the name suggests that it does. The cause of dermatitis herpetiformis is allergy to gluten, a protein found in wheat and some other grains. Symptoms of dermatitis herpetiformis tend to get worse and get better.

Dermatitis herpetiformis is associated with a bowel disorder known as coeliac disease. Small blisters usually develop gradually, mostly on the elbows, knees, buttocks, lower back, and back of the head. Sometimes blisters break out on the face and neck. It may occur in association with gluten (wheat) sensitivity and allergy. All patients with dermatitis herpetiformis probably have subtle changes of this condition - in some it will be clinically apparent, but in most it will be so mild that it causes no symptoms and generally does not require any complicated investigations. 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.

Causes of Dermatitis herpetiformis

The cause of the rash is unknown, dermatitis herpetiformis is frequently associated with gluten (a protein found in cereals) sensitivity in the small bowel. It is seen in both men and women. Persons with dermatitis herpetiformis often have a high incidence of autoimmune disorders and thyroid disease. Dermatitis herpetiformis usually begins in persons 20 and older, though children may sometimes be affected.

Common causes and risk factors of Dermatitis herpetiformis:

  • Celiac disease.
  • A protein found in cereals.

Signs and Symptoms of Dermatitis herpetiformis

The symptoms of dermatitis herpetiformis may resemble other skin conditions. Symptoms of dermatitis herpetiformis tend to get worse and get better. Quite often, blisters and papules occur on the face and neck. Itching and burning may be almost intolerable, and the need to scratch irresistible. Dermatitis herpetiformis 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.

Sign and symptoms may include the following :

  • Symmetric skin eruptions.
  • Blistering skin rash.
  • Itching and burning are often severe.

Treatment for Dermatitis herpetiformis

The gluten-free diet is very difficult, as tiny amounts of gluten are in almost all restaurant and prepared foods, gum wrappers and the like. Cutting down on wheat and gluten may reduce the amount of medication needed, but will not be curative.  Sticking to this diet may remove the need for medications and prevent later complications. Dapsone is a drug that will improve DH in days. Because there can be side effects, the dose of Dapsone is usually started at a small amount, and then raised up over a few weeks until all symptoms are suppressed.

Treatment may include:

  • Dapsone, a medication which can improve symptoms by suppressing the skin response, may be prescribed.
  • A strict gluten-free diet will also be recommended to help control the disease.