Dermatitis herpetiformis

Alternative Names

Duhring's disease

Causes, incidence, and risk factors

Dermatitis herpetiformis usually begins in people age 20 and older, although children may sometimes be affected. It is seen in both men and women.

The cause is unknown. However, dermatitis herpetiformis is frequently linked to gluten sensitivity (celiac sprue disease ) in the small bowel.

Symptoms

Symptoms of dermatitis herpetiformis include:

• Extremely itchy bumps or blisters, most often on the elbows, knees, back, and buttocks
• The rash is usually the same size and shape on both sides
• Some patients may have scratch marks instead of blisters

Symptoms of dermatitis herpetiformis tend to come and go.

Signs and tests

A skin biopsy and direct immunofluorescence test of the skin are performed in most cases. Your doctor may also recommend a biopsy of the intestines.

Treatment

An antibiotic called dapsone may help most patients.

A strict gluten-free diet will also be recommended to help control the disease. Sticking to this diet may remove the need for medications and prevent later complications.

Certain immunosuppressive medications may be used but are less effective.

Expectations (prognosis)

The disease may be well controlled with treatment. Without treatment, there may be a significant risk of intestinal cancer.

Complications

Thyroid disease may be found in many patients with dermatitis herpetiformis. Patients are also more likely to develop certain cancers of the intestines.

Calling your health care provider

Call your health care provider if you have a rash that continues despite home treatment.

Prevention

There is no known prevention of this disease. People with this condition may be able to prevent complications by avoiding foods that contain gluten.

References

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004.

McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. St. Louis, Mo: WB Saunders; 2006.