Dermatitis Herpetiformis Treatments
Having a Dermatitis Herpetiformis problem isn’t just a nuisance, it can be harmful if not treated. Luckily there are several different treatments that can help relieve the symptoms of this condition. Here are some of them.
Symptoms
Symptoms of Dermatitis Herpetiformis (DH) include itchiness and blisters. These can appear anywhere on your body, including your scalp, buttocks, knees, elbows, and back. If you are diagnosed with DH, you will need to follow a gluten-free diet for life to keep it from reoccurring. You will also have to get blood tests to confirm the diagnosis. DH is a type of dermatitis that is closely linked to celiac disease. It is caused by your body’s immune system attacking gluten, a natural protein found in certain grains, such as wheat and rye. It is also linked to other autoimmune disorders, including hypothyroidism, alopecia areata, and vitiligo. DH is more common in men than women. DH may cause complications such as heart problems, thyroid disease, and anemia. It is also known to cause spontaneous miscarriage.
Dermatitis Herpetiformis is often misdiagnosed and can be mistaken for other skin conditions. It can be a difficult condition to manage, so you may want to see a doctor if you have any of the following symptoms: rashes, burning, itching, or blisters. You may also have a family history of DH or celiac disease. DH is usually diagnosed in people between the ages of 15 and 40. However, some people can get DH at any age.
Dermatitis Herpetiformis usually affects only the skin, but it can also affect your joints, hair, and genital area. People with DH are also at a greater risk of developing intestinal cancer. If you have DH, you may need to go on a gluten-free diet to keep the rash from reoccurring. In addition, your doctor may prescribe medication to help alleviate the symptoms.
Dermatitis herpetiformis is sometimes diagnosed by looking at the cells under the top layer of your skin. This can be done by taking a biopsy. The biopsy can reveal the presence of a certain type of IgA protein, which helps confirm the diagnosis. You may also have to undergo specialist testing to confirm the diagnosis. These tests can include blood tests, intestinal biopsies, and skin biopsies. Depending on your condition and the doctor’s evaluation, you may be prescribed a treatment plan, including medications, a gluten-free diet, or a combination of them. Your doctor will also monitor the effects of these medicines. Some medications can be used for a year, while others may be used for a period of two or three years.
If you have a family history of DH, you may want to consider having a bowel biopsy. This can help confirm a diagnosis of celiac disease, which is often associated with DH. If you have a family history of dermatitis herpetiformis, you may also want to consider a gluten-free diet. This can help to keep the rash from reoccurring, as well as reduce the number of medicines you have to take to control the disease.
Diagnosis
Often referred to as the “celiac sprue”, dermatitis herpetiformis is a subepidermal blistering skin disease that is commonly seen in young adults. Dermatitis herpetiformis may present as grouped papules, digital petechiae, vesicles, or blisters. It is characterized by a symmetrical distribution and a cellular rash. Dermatitis herpetiformis is caused by the deposition of an immunoglobulin A (IgA) and e-tissue transglutaminase (e-TG) complex in the papillary dermis.
Dermatitis herpetiformis typically affects the upper back, abdomen, and buttocks, but it can also occur on the legs, scalp, and oral lesions. The rash may be intermittent or may be chronic. Dermatitis herpetiformis can also affect the thyroid gland. The rash usually occurs in tandem with dietary exposure to gluten.
In addition to skin eruption, patients may experience abdominal pain, diarrhea, or weight loss. Dermatitis herpetiformis typically responds to a strict gluten-free diet. Patients are usually offered blood tests for nutritional deficiencies. Those who have abnormal results are typically sent for a small intestinal biopsy. When small intestinal involvement is present, patients are often sent for testing for anti-tissue transglutaminase antibodies, which may indicate celiac disease. This testing can also help to establish adherence to a gluten-free diet.
Dermatitis herpetiformis is usually diagnosed through direct immunofluorescence (DIF) of the skin, but a biopsy may be considered. In a small group of patients, a biopsy of an uninvolved skin was not needed to diagnose dermatitis herpetiformis. Despite this, a biopsy remains the gold standard in establishing the diagnosis of dermatitis herpetiformis.
The typical histologic finding of dermatitis herpetiformis involves neutrophil accumulation at the dermo-epidermal junction. Skin lesions are usually grouped papules and vesicles. Dermatitis herpetiformis skin lesions often have eosinophils at the papillary tip. Occasionally, a skin lesion may appear as a non-diagnostic papular urticaria. Dermatitis herpetiformis lesions may also appear in a pattern that mimics scabies, papular urticaria, or another dermatitis.
Dermatitis herpetiformis has an incidence of 15 to 25%. Dermatitis herpetiformis usually occurs in children and young adults and affects both males and females in a 2:1 ratio. Dermatitis herpetiformis often presents with a blistering rash and itchy, irritated skin. Dermatitis herpetiformis rarely produces complete remission. The majority of patients respond to a gluten-free diet and some respond to oral dapsone medication. Some patients may require the medication for an extended period of time, though the duration of relief varies between days and years. Patients can also take systemic prednisone to provide relief for acute itching.
Patients may also experience mild anemia. This may be due to folic acid deficiency or malabsorption associated with gluten-sensitive enteropathy. Patients who have dermatitis herpetiformis are at a higher risk of developing bullous pemphigoid. In addition, patients who have celiac disease are at a higher risk of developing lichen planus. Dermatitis herpetiformis and bullous pemphigoid are both autoimmune disorders.
Treatment
dermatitis herpetiformis (DH) is a condition characterized by blisters and vesicles, which appear on the skin. It usually occurs on the extremities, especially the elbows and knees. A diagnosis of DH is made based on clinical presentation, serology, and histology. It is also possible to make a diagnosis based on the presence of other autoimmune diseases.
Dermatitis herpetiformis occurs in 15% to 25% of coeliac disease patients. DH is caused by a gliadin-fiber intolerance. Gluten is present in wheat, rye, and barley. Gluten causes inflammation in the gastrointestinal tract, which can lead to intestinal villous atrophy, weight loss, and fatigue. This rash is usually itchy and is characterized by small, fluid-filled blisters, vesicles, and papules. DH is associated with an increased risk of bullous pemphigoid. DH is also associated with non-Hodgkin lymphoma (NHL).
The most common symptoms of dermatitis herpetiformis are itch and swelling. The condition may also lead to burning and scarring. Patients may also experience weight loss and fatigue. Dermatitis herpetiformis may be associated with a family history of autoimmune diseases. A gluten-free diet is the most effective treatment for DH. However, it is not effective in all cases.
When dermatitis herpetiformis is suspected, patients must be referred to a dermatologist. Dermatologists can perform special tests to confirm the diagnosis. They will also determine the appropriate treatment for the patient. The treatment may involve topical or oral antibiotics. The oral antibiotic dapsone may help to control the rash. It is recommended that patients take a starting dose of 25-50 mg per day and increase the dose if necessary. Dapsone is a sulfone drug and has potent antimicrobial properties. It suppresses the formation of new lesions for up to two days. It is used as second-line therapy for DH.
Patients with DH should have their thyroid function checked as well. The presence of thyroid function abnormalities is associated with the disease. It is usually recommended that patients have thyroid function tests after a diagnosis of dermatitis herpetiformis. In addition, patients with DH should be screened for iron deficiency and folic acid deficiency, which may lead to anemia. If a folic acid deficiency is found, the patient will need to take folic acid and vitamin B12 supplements.
Dermatitis herpetiformis is also associated with an increased risk of bullous pemphigoid. In addition to dermatitis herpetiformis, the coeliac disease may cause diarrhea. The small bowel villous atrophy that occurs in coeliac disease may be present in dermatitis herpetiformis. A small bowel biopsy may be performed to assess the villous atrophy. It may be normal because of skip lesions or because the patient has a gluten-free diet.
A lifelong gluten-free diet is recommended for patients with dermatitis herpetiformis. This will lead to the resolution of the rash and improve the patient’s quality of life. It will also reduce the risk of developing NHL.
Health Sources:
Health A to Z. (n.d.). HSE.ie. https://www2.hse.ie/az/
U.S. National Library of Medicine. (n.d.). https://www.ncbi.nlm.nih.gov/
Directory Health Topics. (n.d.). https://www.healthline.com/directory/topics
Health A-Z. (2022, April 26). Verywell Health. https://www.verywellhealth.com/health-a-z-4014770
Harvard Health. (2015, November 17). Health A to Z. https://www.health.harvard.edu/health-a-to-z
Health Conditions A-Z Sitemap. (n.d.). EverydayHealth.com. https://www.everydayhealth.com/conditions/