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  Dermatitis Herpetiformis  
 
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Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations

 

Dermatitis herpetiformis (DH) is a severe itchy, blistering skin disease caused by gluten intolerance. DH is related to celiac disease since both are autoimmune disorders caused by gluten intolerance, but they are separate diseases. The rash usually occurs on the elbows, knees, and buttocks.

Although people with DH do not usually have digestive symptoms, they often have the same intestinal damage as people with celiac disease.

DH is diagnosed by a skin biopsy, which involves removing a tiny piece of skin near the rash and testing it for the IgA antibody. DH is treated with a gluten-free diet; conventional medication such as dapsone or sulfapyridine may be used to control the rash but may be required for several years.
 

 
 

Conditions that suggest Dermatitis Herpetiformis:
 
 
Lab Values  Eosinophilia
 
 

Risk factors for Dermatitis Herpetiformis:
 
 
Autoimmune  Autoimmune Tendency
 
 

Dermatitis Herpetiformis suggests the following may be present:
 
 
Allergy  Allergy / Intolerance to Foods (Hidden)
 Not all people with Dermatitis Herpetiformis improve on a gluten free diet and medication. Some studies suggest that sensitivity to other dietary proteins may be involved. An elimination diet or allergy testing should be done to check for other food sensitivities.

Autoimmune

  Autoimmune Tendency

Digestion

  Hydrochloric Acid Deficiency
 People with Dermatitis Herpetiformis frequently have mild malabsorption associated with low stomach acid and should consider an HCL trial.
 
 

Recommendations for Dermatitis Herpetiformis:
 
 
Diet  Gluten-free Diet
  Dairy Products Avoidance
 A milk-free diet may improve symptoms of dermatitis herpetiformis. The intake of milk products intensified symptoms of DH in two patients despite adherence to a gluten-free diet and a milk and gluten-free diet was effective. [Lancet 1971;2: pp.438-9]

Vitamins

  Vitamin Paba
 Para-aminobenzoic acid (PABA) in large doses (10 to 25gm per day) may reduce or eliminate the skin lesions of DH. People with DH have remained symptom-free for as long as 30 months. Because of these high doses, a watchful eye should be kept for any evidence of side effects. [Arch Dermatol Syph 1951;63: pp.115-32]
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Likely to help
Highly recommended







GLOSSARY

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Antibody:  A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

Autoimmune Disease:  One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Biopsy:  Excision of tissue from a living being for diagnosis.

Celiac Disease:  (Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.

Dermatitis:  A general term used to refer to eruptions or rashes on the skin.

Hydrochloric Acid:  (HCl): An inorganic acidic compound, excreted by the stomach, that aids in digestion.

IgA:  Immunoglobulin A. Supports mucosal immunity.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.