Dermatitis Herpetiformis

  • Intensely pruritic, chronic, recurrent, papulovesicular disease.
  • Underlying gluten-sensitive enteropathy - may be asymptomatic.
  • Pruritus - first & predominant symptom.
  • Symmetrical eruption of grouped erythematous papules and papulovesicles rapidly excoriated - intact vesicles are difficult to demonstrate.
  • Extensor aspects of limbs (elbows and knees), buttocks, natal cleft, shoulders, upper back, face and scalp.
  • Oral lesions are common but asymptomatic.
  • Provocation of lesions occurs with iodides.

Secondary infection and ulceration

  • Antigen: Gut epithelial antigen cross reacts with skin
  • Antibodies: IgA directed against gliadin and autoantigens like reticulin and endomysium C3, IgG, IgM may be seen

Stick to a gluten free diet

  • Onset usually between 20-55 Years.
  • Mainly males.
  • External factors: Gluten containing diet like wheat, barley, oats and rye.

How is it diagnosed?

Investigation
  • Histology of intact vesicles reveals neutrophilic microabscesses at the tips of dermal papillae.
  • Direct immunofluorescence on clinically normal skin (buttocks) - granular IgA deposits in dermal papillae.

How is it treated?

  • Strict gluten free diet
  • Dapsone 100-200 mg/day
  • Sulphapyridine 1.5 g/ day
  • Tetracycline with nicotinamide
  • Colchicine when the above drugs are contraindicated

Consult with experienced Doctors

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