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Dermatitis herpetiformis

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Dermatitis herpetiformis, also known as Durhring’s disease, is a rare type of autoimmune skin disorder characterized by itchy blisters that erupt on the surface of the skin. Dermatitis herpetiformis, or DH, is a disorder that has been associated closely with gluten-sensitive enteropathy, also known as celiac disease (CD).

The blistering is actually an immunological reaction stemming from the immune system’s abnormal intolerance to gluten, a substance found in wheat, what products, and other grains. Similar to the reaction of people who have celiac disease, Dermatitis herpetiformis involves an allergic reaction from immunoglobulin A (IgA) antibodies that manifests as an outbreak of a skin rash that also occurs as a symptom of celiac disease.

DERMATITIS HERPETIFORMIS DIAGNOSIS

Patients diagnosed with DH have similar changes in the immunologic reaction and intestinal mucosa as those diagnosed with celiac disease. Their common factor is an allergy to gluten. In medical circles, Dermatitis herpetiformis is often called “celiac disease of the skin”, while CD is familiarly known as “celiac disease of the gut”.

About 80% of patients who suffer from Dermatitis herpetiformis are found to have gluten enteropathy, a typical and common form of celiac disease, and approximately 20% of patients suffering from celiac disease have DH blisters. Though less common, DH is also a symptom in people with thyroid disease.

The skin disorder usually manifests itself in young adults, particularly in more males compared to females who are genetically predisposed to it, although the disease may also affect children. It is likewise prevalent in people who can trace their origins to northern European countries.

Itchy bumps and blisters that appear on the surface of the scalp, elbows, knees, back, and buttocks characterize dermatitis herpetiformis. This skin disorder is chronic in nature and may appear intermittently over an extended period of time.

DERMATITIS HERPETIFORMIS SYMPTOMS

The symptoms of Dermatitis herpetiformis take the form of raised bumps (papules) and water-filled blisters (vesibles) that measure up to a centimeter wide and form in clusters. These bumps and blisters are the equally shaped and sized on both sides, and they usually appear only on the surface of the skin on the scalp, elbows, back, buttocks, and knees. An afflicted person will feel a burning sensation on the area of skin where a bump or blister is set to appear.
Dermatitis herpetiformis
Image: Dermatitis Herpetiformis


These skin irritations are extremely itchy, and depending on their number and severity, they heal in a week or two, becoming scabs. However, new outbreaks frequently occur as the old ones heal. These bumps and blisters may occur from one week to the next and can only be eradicated with proper treatment. While Dermatitis herpetiformis is a lifelong affliction, infected patients may go into remission in 10% to 20% of cases.

In patients with accompanying Gluten enteropathy, the intestines appear smooth and flattened instead of having normal convolutions. Because of this, nutrient absorption is impeded and patients may suffer from fatigue, abdominal bloating and discomfort, constipation or diarrhea, loss of weight, pale and lightweight stools, and very rarely, bone fractures stemming from osteoporosis.

People who are afflicted with Dermatitis herpetiformis break out in bumps and blisters when they inadvertently consume food that contains gluten, such as wheat, wheat products and other grains. An abnormality in their immune system in the form of IgA antibodies that are found in the intestinal lining reacts to gluten, and the substance enters the bloodstream where it begins to clog up the millions of miniature blood vessels that are found in the skin. This action attracts the neutrophils, white blood cells that then release potent chemicals that cause rashes, bumps and blisters to form. The reaction is especially powerful when a person has a good amount of iodine in their system. This is why patients who have been diagnosed with DH avoid ingesting iodized salt with their food.

The allergy may also spread to a person’s gut in a complication known as celiac disease. This gluten-sensitive enteropathy may occur in some people with Dermatitis herpetiformis, and sometimes people with celiac disease may not exhibit symptoms of DH at all.

To diagnose Dermatitis herpetifomis, the doctor will examine the appearance of a patient’s skin outbreaks to check if the blisters form beneath the epidermis and if the bumps converge in several inflammatory groups. The doctor will then take a skin biopsy of a bump or a blister to determine whether there is a large amount of IgA in the dermis.

The doctor may likewise order a blood test to check for the presence of anti-gliadin, anti-endomysial, or anti-reticulin antibodies. Some telltale signs of a gluten allergy will show up as mild anemia, as well as iron and folic acid deficiency. There are certain tests to detect autoantibodies such as a screening test for total IgA antigliadin and anti-endomysial antibodies. Patients who have accompanying celiac disease may even undergo small bowel biopsy to check for any affliction of the gut associated with gluten enteropathy symptoms.

DERMATITIS HERPETIFORMIS TREATMENT

When Dermatitis herpetiformis is diagnosed, treatment may be life-long as DH is a chronic disease. Patients will need to eliminate gluten from their diet to prevent further allergic reactions, and while this may improve their skin condition, it may take as long as several months. This is particularly difficult as most pre-prepared food, such as food from restaurants, may contain it in varying amounts.

To reduce the severity of outbreaks, doctors may prescribe the antibiotic Dapsone in small amounts to suppress the skin symptoms of DH. Dapsone has been known to bring about some side-effects and patients will need to have their blood tested on a weekly basis during the first three months of using this medication. Alternative treatments such as sulfapyridine and tetracycline may also be used, and although they do not have the side effects brought about by Dapsone, they are not as effective in treating outbreaks of bumps and blisters.

DERMATITIS HERPETIFORMIS PREVENTION

While Dermatitis herpetiforms cannot be prevented entirely, people who have been diagnosed with this disease will need to avoid ingesting any type of food that contains gluten in order to prevent skin outbreaks. DH can be controlled with proper treatment, without which a patient increases their risk for intestinal cancer.
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