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Definition

Dermatitis Herpetiformis (DH) is an important associated disorder or complication of celiac disease which is manifested in the form of a skin rash. This disease usually presents in patients 30 to 40 yr old and is rare in blacks and Asians. It is an autoimmune disease. These are more common on the knees, elbows, buttocks and shoulder blades. The disease is twice as common in men as in women. It predominantly affects persons between the ages of 20 and 50 years.

Causes

Dermatitis herpetiformis is caused by proteins called glutens found in foods containing wheat, barley, or rye. Normally, the immune system sends antibodies to attack foreign invaders in the body, such as infections. They actually create the rash. Iodine is required for the reaction, so people with DH should avoid using Iodized salt.

Symptoms

Dermatitis herpetiformis is usually extremely itchy. The lesions may first appear as discolorations and next consist of small bumps called papules and small blisters called vesicles. The bumps or blisters usually appear on the elbows, knees, back, and buttocks.
Some indications of malabsorption that may result from celiac disease include:

  • Weight loss
  • Diarrhea
  • Abdominal cramps, gas and bloating
  • General weakness
  • Foul-smelling or grayish stools that may be fatty or oily
  • Stunted growth (in children)
  • Osteoporosis

Treatment

Just as with celiac disease, strictly following a gluten-free diet for life is the only complete treatment. It may take two or more years on a gluten-free diet for the lag deposits under the skin to clear.

Standard treatment frequently involves the use of dapsone to treat the rash. This brings symptomatic relief within 1 or 2 days. The urgent need to scratch usually abates in 1 to 3 days.

IgA is an antibody produced in the mucous membranes of the nose, throat, lungs and gut. IgA is produced by the body in response to foreign substances (antigens) which are breathed in or taken in with food.

However, some people can never discontinue the drug. In most people, any reexposure to gluten, however small, will trigger another outbreak. A gluten-free diet may prevent the development of intestinal lymphoma.
T-lymphocytes in the small intestinal mucosa of celiac disease and dermatitis herpetiformis subjects on a normal diet has been studied and compared to normal controls.

Non-Hodgkin’s lymphoma, affecting the intestines or any part of the body, is a serious complication of gluten enteropathy but is fortunately rare, affecting less than 1% of patients.

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