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
Dermatitis Herpetiformis rash on abdomen
Management
Gluten free diet for life to control symptoms and reduce risk of small bowel lymphoma
If unsuccessful
- Dapsone (antibacterial)
- Sulphapyridine (sulphonamide ABx)
References
- British Association of Dermatologists: Dermatology, a handbook for medical students & junior doctors
- bad.org.uk
- dermnetnz.org
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