DERMATITIS, HERPETIFORMIS

General Information

DEFINITION--A chronic skin inflammation characterized by clusters of small itching blisters. The disorder is hereditary but not contagious or cancerous.

BODY PARTS INVOLVED--Skin of the elbows, knees, shoulders, arms, legs and over the bottom of the spine (sacrum).

SEX OR AGE MOST AFFECTED--Adolescents and adults.

SIGNS & SYMPTOMS--

Lesions with the following characteristics:

• Lesions are small clusters of 5 to 20 blisters. Blisters usually measure 2mm to 6mm in diameter.
• Clusters appear on both sides of the body in the same places.
• Lesions itch, but they are not usually painful if there are no complications. May feel a burning or stinging sensation.

CAUSES--Unknown, but may be a disorder of the autoimmune system.

RISK INCREASES WITH

• Exposure to heat and humidity.
• Gluten sensitivity (protein found in wheat and other foods that cannot be digested by some persons because of genetic disease).
• Family history of dermatitis herpetiformis.

HOW TO PREVENT--Cannot be prevented at present. To prevent a recurrence of symptoms, continue to take medication as directed and prevent injury to normal skin.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Biopsy (See Glossary).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment with medication.

POSSIBLE COMPLICATIONS--People with dermatitis herpetiformis also may have disease of the small bowel (without symptoms), which pathologically resembles that of patients who are intolerant to gluten. The only way to diagnose this is with biopsy.

PROBABLE OUTCOME--This is a chronic disease. Treatment can control symptoms--including itching--but it will not cure the disease.

How To Treat

GENERAL MEASURES----Soak in cool water or use cool-water compresses to reduce itching.

MEDICATION--

• For itching, you may use non-prescription drugs such as: Low-dose steroid lotion, ointment and cream. These reduce inflammation and itching in 24 to 48 hours. Topical anesthetics and topical antihistamines. These provide quick, short-term relief. Many cause skin sensitivity, but lidocaine and pramoxine usually do not. Lotions containing phenol, menthol and camphor (such as calamine lotion). These are soothing, but use with care. Large amounts may be absorbed through the skin into the bloodstream; they can be toxic.
• To control blistering, your doctor may prescribe two oral medications, dapsone or sulfapyridine. If either one is needed, it will be required indefinitely.

ACTIVITY--No restrictions, except avoid overheating and moisture.

DIET--Restricting gluten in your diet will reduce the amount of medicine you will need. For a gluten-free diet, see Appendix.

Call Your Doctor If

• You have symptoms of dermatitis herpetiformis.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.