Dermatitis herpetiformis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Overview
Dermatitis Herpetiformis (also called Duhring's disease), is a chronic itchy rash which is frequently associated with Celiac Disease. The rash is made of papules and vesicles which are present on different parts of the body mostly commonly on neck, trunk, buttocks and knees. It is an autoimmune mediated skin condition, which is IgA mediated reaction and is associated with gluten sensitivity of small bowel. There is presence of antibodies which leads to positive serology test results.
Dermatitis herpetiformis is associated with high prevalence of other autoimmune diseases.
Medical Therapy
The first line pharmacotherapy is dapsone with lifestyle changes, which is adherence to gluten free diet. The other options are sulfonamide drugs and corticosteroid. There is an immediate response to dapsone, the pruritus resolve in 72 hours while the cutaneous rash take days. New eruptions might be noticed on dapsone but it does not indicate increase of the dosage and can be treated with topical corticosteroids. Dapsone should not be used in patients with glucose-6-phospate deficiency,other adverse effects are agranulocytosis, hypersensitivity reaction, and methemoglobinemia. Dapsone should be tapered when the patient strictly adhere to the diet for 3-6 months, while being closely observed for reappearance of symptoms.
Sulfapyridine and sulfasalazine are the other options which does not have the side effects of like dapsone, although the patient is instructed to stay hydrated because of the risk of drug-induced nephritis. The use of steroid in only to reduce pruritus, while no effect of systemic steroids is noticed.[1][2].
References
- ↑ ite Sanders SW, Zone JJ. The relationship between dapsone dose, serum concentration and disease severity in dermatitis herpetiformis. Arzneimittelforschung. 1986;36(1):146-9. PMID: 3954818.
- ↑ Reunala T, Blomqvist K, Tarpila S, Halme H, Kangas K. Gluten-free diet in dermatitis herpetiformis. I. Clinical response of skin lesions in 81 patients. Br J Dermatol. 1977 Nov;97(5):473-80. doi: 10.1111/j.1365-2133.1977.tb14122.x. PMID: 588461