Dermatitis Herpetiformis (DH) is also commonly known as Duhring’s disease which is a chronic skin condition characterized with occurrence of fluid filled blisters. Despite its name Dermatitis Herpetiformis, it is not caused by Herpes virus neither it is linked with it in anyways. The condition derives its name because it is an inflammatory condition of the skin which appears to be similar to herpes. DH was described by Louis Adolphus Duhring for the first time in 1884. In the year 1867 a link was determined between Dermatitis Herpetiformis and celiac disease which is gluten intolerance. However, its exact mechanism was not known.
Though the condition can affect anyone it is mostly found to occur between age group of 15 to 40 years. Men and women are at equal risk of the condition. It is estimated that the condition can affect 0.25% to 1% people of the entire population. The disease is common in European individuals.
Causes of Dermatitis herpetiformis
This condition is wrongly considered to be a rash. However, this irregularity occurs in people affected with celiac disease which is considered to be allergy or gluten intolerance. Gluten is a protein which is contained in wheat, barley, oats and rye. Celiac disease is also referred to as gluten sensitive enteropathy or celiac sprue. It is recorded that around 15% individuals suffering from celiac disease also suffer from Duhring’s disease. Celiac disease often causes intestinal symptoms but in some cases it may be nondescript, without any underlying complications; however, in 90% cases intestinal damages are recorded. Intestinal damages and rashes often appear due to gluten protein reaction with a certain kind of antibody known as IgA. Body produces antibodies as a response to toxins or infections. In some cases such antibodies are produced due to environmental substances, pollen, dust mite and foods. This is what we refer to as allergy.
When celiac disease is prevalent the body produces IgA to attack gluten proteins. Such sensitivity to gluten is often genetic and may run in families. When IgA attacks gluten they destruct the small villi structures in the intestine that enables body to absorb nutrients and essential vitamins. Wgen IgA bounds with gluten the structure starts forming and enters into bloodstream. They clog small blood vessels, mainly those associated with the skin. This blockage attracts white blood cells which then releases chemical known as ‘complement’ that leads to blistery rashes which may be itchy in some cases.
Symptoms of Dermatitis Herpetiformis
Dermatitis herpetiformis is often typified through chronic papulovesicular eruption which may be itchy often. These are often seen on extensor region such as back of the neck, scalp, knees, hairline, scrotum, buttocks, etc. The blisters may differ in size from tiny eruptions to as large as 1 cm. Dermatitis herpetiformis is often itchy and accompanied with overwhelming desire to scratch. Sometimes the affected individual may scratch the blisters even before they are examined. In some cases intense burning sensation and itching is also experienced before the blisters appear on that particular spot.
DH associated complications and severity may vary overtime if the condition is left untreated, depending on the gluten ingestion amount. The symptoms of this disease mostly appear during early adulthood between the age group of 20 to 30 years. Though the initial symptoms of DH are burning and itching sensation the first sign of the issue is occurrence of papulse or vesicles that may appear like blisters or red bumps. These blisters may sometimes appear on face and along the hairline. Sometimes they may also appear in mouth or shoulders. These symptoms of the condition may range from mild to severe but may disappear with appropriate treatment and avoiding gluten consumption.
Symptoms of this condition are often chronic and affect in episodes with short time intervals. In some cases these symptoms may be accompanied with symptoms of coeliac disease which usually includes stomach pain, bloating, fatigue and loose feces. There are three stages of DH rash appearance and disappearance. Skin discoloration at the affected site is the first stage. The second stage causes the lesion to transform into visible papules and vesicles that often appear as clusters. In the third and last stage of the condition the lesions heal and color change is noticed. This may cause the affected skin area to appear either darker or lighter than the surrounding skin.
Dermatitis herpetiformis is usually confused with other conditions such as drug eruptions, scabies, dyshidrosis and contact dermatitis etc. The doctor may suggest a blood test to evaluate IgA antibodies which usually is enough to confirm the diagnosis of the condition. Skin biopsy is often co-suggested as it indicates IgA presence in dermal papillae. Tests should be undergone before the affected individual starts with gluten free diet. If the patient is already following a gluten free diet then he/she may have to start using gluten for few weeks before taking the test in order to get proper diagnostic.
Dermatitis Herpetiformis treatment
Usually treating Dermatitis herpetiformis involves a combination of medicine and diet. Long term diet plan which does not include gluten will help in reducing DH to significant level. To your information gluten free diet can also help in treating Coeliac disease. However, relying only on diet may take month even years to control the condition. Hence, to control the symptoms of the condition one should use medicines as suggested by doctor. Medicines help in controlling the rashes significantly. The medicine that widely used to treat dermatitis herpetiformis is Dapsone. This medicine is often suggested in oral form. There may be side effects of Dapsone, hence regular check-up is essential.
Dapsone has side effects that can be serious. Some of these complications include liver irregularities, anemia, sensitivity to sun, weakness of muscles, peripheral neuropathy, etc. These can prove to be of serious nature, thus taking the drug according to instructions from a doctor is essential. There are other drugs that are suggested for treating dermatitis herpetiformis, but these are not as effective as Dapsone. These medicines include tetracycline, immunosuppressive medications and sulfapyridine. However, any treatment that you consider should be in accordance to approval and instructions of a doctor.