Dermatitis Herpetiformis

Original article by Nick Lower | Last updated on 11/5/2014
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Aetiology

  •  Adulthood (20-40)
  •  Coeliac’s disease (transglutaminase)
  •  M:F 2:1
 

Pathophysiology

  • Deposition of  IgA in papillary dermis causing an immunological cascade
  • Is an immunologic response to chronic stimulation of the gut mucosa. IgA react to gluten-tissue transglutaminase (t-TG) in the gut, and epidermal transglutaminase (e-TG).
  • Genetic predisposition with HLA expression (10% have affected relative)
 

Signs & Symptoms

  • Suicidally itchy’ blisters and papules. Intensely pruritic
  • Often few blisters as most are scratched and therefore appear as papules
  •  Intermittent cutaneous lesions mainly affecting the buttocks, knees and elbows
  • Rraely any bowel symptoms of coeliac's disease
 

Management

Gluten free diet for life to control symptoms and reduce risk of small bowel lymphoma
If unsuccessful
  • Dapsone (antibacterial)
  • Sulphapyridine (sulphonamide ABx)

 

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