Dermatitis Herpetiformis

Don't be fooled by the herpetiformis in its name - dermatitis herpetiformis (DH) has nothing to do with herpes. It's actually an autoimmune disease associated with celiac disease, and probably the itchiest thing a human being can experience. Also known as Duhring's disease, it's often mistaken for dyshidrotic eczema, contact eczema, or scabies because of the way it presents itself on the skin.

The exact cause of dermatitis herpetiformis is still unknown. DH has been linked to celiac disease, which is an allergy to gluten, a protein found in wheat and rye. Most of the people who have DH also have celiac disease, although not all people with celiac disease develop DH.

Symptoms

Because of its appearance, this condition is commonly dismissed as a number of other skin issues. It's necessary to do a blood test and a skin biopsy to confirm the diagnosis of DH.

Dermatitis herpetiformis symptoms include:

  • Symmetrical rash - Appears on head, elbows, knees, lower back, or buttocks.
  • Extreme itching or burning - Of the affected area of the skin.
  • Celiac disease symptoms - These may also be present, which include bloated stomach, anemia and foul-smelling diarrhea. 

People with DH usually have their first symptoms in their 20's or 30's, although it's possible for the symptoms to appear earlier in life. The rash consists of small blisters, papules and lesions that look like hives. They appear symmetrically on the skin and cause severe itching or burning sensations, making it hard to refrain from scratching.

Over time, persons with DH are likely to suffer from intestinal damage, especially if they continue eating foods that contain gluten.

Treatments

This type of dermatitis responds well to a gluten-free diet and the antibiotic Dapsone.
Tetracycline and nicotinamide, heparin, and sulfamethoxypyridazine are also a treatment option for people who can't take Dapsone.
   
The gluten-free diet, although it can be hard to follow, is absolutely essential for managing dermatitis herpetiformis. Gluten will over time damage the intestines of a person who has DH, which may lead to further complications. Also, avoiding gluten will help reduce the doses of medications needed to manage the disease, and maybe even eliminate the need for them. This is especially important when taking Dapsone because of its side-effects.

The key to dealing with dermatitis herpetiformis is the gluten-free diet. Dapsone may help with itching, but the diet will confront the root cause. A gluten-free diet is not an easy thing to maintain. Gluten can be found in a lot of foods, not only those made from wheat or rye, and your country may not have rules that require manufacturers to declare the amount of gluten on standard food packaging.

You can look for specialty shops that sell gluten-free food, but be aware that even those can contain trace amounts of gluten.
   
Dapsone is an antibiotic and the most effective drug for dealing with symptoms of dermatitis herpetiformis. It should, however, be used with much caution because of its side-effects, which include hemolysis. Any person on Dapsone should also have regular blood tests done to track the side-effects of the drug. If, for any reason, a person cannot take Dapsone, there are a number of alternative therapies available.


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