"A skin biopsy and direct immuno-fluorescence test of the skin are performed in most cases. Your doctor may also recommend a biopsy of the intestines."
Dermatitis herpetiformis is an extremely itchy rash made of bumps and blisters. The rash is chronic, which means it continues over a long period of time.
Dermatitis herpetiformis, also known as Duhring disease, is a rare, chronic, skin disorder characterized by the presence of groups of severely itchy (pruritic) blisters and raised skin lesions (papules). These are more common on the knees, elbows, buttocks and shoulder blades. The exact cause of this disease is not known although it is frequently associated with the inability to digest gluten (gluten sensitive enteropathy [GSE] or celiac sprue).
The age of onset is usually about 15 - 40, but DH can also affect children and the elderly. Men and women are equally affected. Estimates of DH prevalence vary from 1 in 400 to 1 in 10000.
Symptoms:
Dermatitis herpetiformis is usually extremely itchy. The bumps or blisters usually appear on the elbows, knees, back, and buttocks. In most cases, the rash is the same size and shape on both sides.
Although the first signs and symptoms of dermatitis herpetiformis are intensive itching and burning, the first visible signs are the small papules or vesicles that usually look like red bumps or blisters. Sometimes they appear on the face and along the hairline, and, on occasion, on the shoulders, the lower end of the spinal column, and within the mouth. The rash rarely occurs on other mucous membranes, excepting the mouth or lips. The symptoms range in severity from mild to serious, but they are likely to disappear if gluten ingestion is avoided and appropriate treatment is administered. However, the consumption of aliments that contain gluten as well as oral contraceptives may exacerbate the symptoms. Symptoms of dermatitis herpetiformis tend to come and go.
Signs and tests:
A skin biopsy and direct immuno-fluorescence test of the skin are performed in most cases. Your doctor may also recommend a biopsy of the intestines.
Treatment:
Dermatitis herpetiformis responds well to medication and changes in diet.
Dapsone, an antibiotic, may help most patients.
A strict gluten-free diet must also be followed, and this will usually be a lifelong requirement. This will reduce any associated intestinal damage and the risk of other complications. After some time on a gluten-free diet, the dosage of dapsone can usually be reduced or even stopped, although this can take up to 1 to 3 years.
Expectations:
The disease may be well controlled with treatment. Without treatment, there may be a significant risk of intestinal cancer.
Thyroid disease may be found in many patients with dermatitis herpetiformis. Patients are also more likely to develop certain cancers of the intestines. Call your health care provider if you have a rash that continues despite home treatment.
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