Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is “celiac disease of the skin”.  Genetic factors, the immune system, and sensitivity to gluten all play a role.  About 10% of patients with celiac disease present with DH.

Symptoms

Dermatitis herpetiformis (DH) is characterized by a chronic, intensely itchy skin rash. The rash starts as small blisters with severe itch and burning sensation.  With constant itching, scabs form and secondary infection may also occur.  The most common areas affected are the elbows, knees, buttocks, back of the neck, scalp, and upper back. The rash generally has a symmetric distribution.

Gastrointestinal symptoms such as abdominal pain, bloating and diarrhea may or may not be present in patients with DH.

DH affects males and females equally. Onset is most frequently in the late second to the fourth decades of life.

Diagnosis

Diagnosis of DH can be made by a dermatologist with a skin biopsy. Most patients with DH will have an abnormal small intestinal mucosa (lining) and an intestinal biopsy is generally not required.

Treatment

Like celiac disease, treatment of DH consists of lifelong adherence to a strict gluten-free diet.  Some patients may require medication (Dapsone) initially. Complete resolution of symptoms may take some time.

 

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