Dermatitis herpetiformis is associated with a bowel disorder known as coeliac disease. Small blisters usually develop gradually, mostly on the elbows, knees, buttocks, lower back, and back of the head. Sometimes blisters break out on the face and neck. It may occur in association with gluten (wheat) sensitivity and allergy. It is characterized by the presence of IgA deposits in the upper dermis skin and the diagnosis should not be made in the absence of these deposits. It is also known as Brocq-During disease, dermatitis multiformis, Duhring disease, and gluten-sensitive enteropathy. Symptoms Symptoms of dermatitis herpetiformis are intense burning, stinging and itching around the elbows, knees, scalp, buttocks and back. More locations can also be affected and the severity can vary. Scratching will further irritate the eruptions. Eruptions commonly occur on pressure points, such as around the elbows, the front of the knees, the buttocks, back face, and scalp but can appear anywhere on the body. Eruptions are usually bilateral - occurring on both sides of the body. Ingestion of gluten plays a role in the exacerbation of skin lesions. Causes Dermatitis herpetiformis is associated with a bowel disorder known as coeliac disease. Virtually all patients with dermatitis herpetiformis probably have subtle changes of this condition †in some it will be clinically apparent, but in most it will be so mild that it causes no symptoms and generally does not require any complicated investigations. In both conditions the patients are sensitive to gluten, a protein found in wheat and rye flour; and an immunological reaction to gluten plays an important part in causing the rash of dermatitis herpetiformis. Dermatitis herpetiformis usually begins in persons 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. Diagnosis To diagnose dermatitis herpetiformis, the doctor will test the person's blood for autoantibodies related to celiac disease and will take a biopsy of the person's skin. If the antibody tests are positive, and the skin biopsy has the typical findings of dermatitis herpetiformis, patients do not need to have an intestinal biopsy. Treatment The blisters do not go away without treatment. The drug dapsone, taken by mouth, almost always provides relief in 1 to 2 days, but requires that blood counts be checked regularly. Once the disease has been brought under control with drugs and the person has followed a strict gluten-free diet (a diet that is free of wheat, rye, and barley) for 6 months or longer, drug treatment usually can be discontinued. However, some people can never discontinue the drug. In most people, any reexposure to gluten, however small, will trigger another outbreak. Dapsone is the usual and main medication for Dermatitis herpetiformis (DH), the skin condition related to Celiac Sprue. Unfortunately, Dapsone is not an innocuous drug. I have had DH several years. I took the nasty drug at first and was mighty glad to get it, 'cause it works. Nothing else really does. But no one would want to take it forever. It ALWAYS, in ALL people, causes significant damage to the red blood cells, producing hemolytic anemia, which in most cases amounts to about 2 grams Hemoglobin.
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