The Dermatitis Herpetiformis rash is normally found on the knees and elbows and sometimes on the buttocks, but not all patients with celiac disease will have this condition as well. There are many intestinal abnormalities related to dermatitis herpetiformis. About 20 percent of patients with dermatitis herpetiformis have intestinal trouble associated with celiac disease.
A complete blood count or CBC will be ordered and this will show the auto antibodies that are related to celiac disease, and more than likely a small biopsy of the rash affected skin will be taken as well. There will be antibody tests performed, and if they come back positive, then the skin biopsy will have normal findings of DH. This means there is no reason to do an intestine biopsy which is painful, but normally conclusive.
Treatment for Dermatitis Herpetiformis
A gluten free diet is normally suggested to keep recurrence from happening, which normally happens when glutens are reintroduced into the diet. The rash symptoms are controlled with dapsone, while the gluten free diet helps with the intestinal conditions therein. Dapsone or diaminodiphenyl sulfone and slufapyridine are the normal medications given for the DH, and rapid improvement should be seen.
If it is found that a patient cannot use the dapsone due to hemolysis, the sulfapyridine can be used instead. These medications inhibit the neutrophil migration into the area of irritation. Gluten free diets consist of no wheat, barley or rye products. There have also been cases reported that have ceased after trying the Atkins Diet. Lesser treatments include cyclosporine, but should be used with caution because these patients can have a potential increased risk of intestinal lymphomas due to this treatment.
Prednisone and azathiorprine as well as UV light and colchicines are also used. Each of these medications can cause upset stomach, and should not be ceased without a physician’s recommendation. These are versions of steroids that reduce swelling and help the body to fight off infections, and are used not only for this disease, but many conditions. Hormonal conditions as well as asthma and Crohn’s disease are just a few that also share these medications. UV lights are used in many patients that suffer from psoriasis as well as this disease, and it is useful in giving vitamins to the skin that are essential to renewal and growth.