Duhring’s disease belongs to the group of herpesform dermatoses. This group includes diseases that have different causes, but are similar in clinical manifestations. For all herpetiform dermatoses, including dermatitis, a specific grouping of rashes is characteristic. It has a chronic course, lasting 20-30 years. For dermatitis herpetiformis, periods of prolonged remission are characteristic which are followed by exacerbations.
With adequate treatment, the process gradually subsides, the periods of remission become more and more prolonged. If this disease manifested in childhood, it is often observed spontaneous cure until the end of puberty.
Causes of dermatitis herpetiformis:
Heredity is one of the main factors that can cause it but the exact causes have not been found to date. It is believed that this disease is polysystemic. Part of dermatologists believes that the hereditary factor plays a big role in the development of illness. The confirmation of this theory is that most of the patients have non-inflammatory bowel disease caused by hypersensitivity to gluten of cereals. In addition, a certain role in the development of illness plays a high degree of sensitivity to iodine. The autoimmune nature of disease is confirmed by the detection of the presence of IgA in the tissues of the dermis. There are a lot of theories about the origin, but according to today’s ideas, the disease arises from a violation of absorption in the small intestine and manifests itself in the form of reaction to gluten and the subsequently immune-alergic reactions.
The first symptoms are unbearable itching, tingling, burning, which occur on visually unchanged skin. After a while there are rashes in the form of spots, nodules, pustules, blisters and mostly bubbles. Vesicles are usually shallow, deep, fluid-filled, and dense in consistency. The content of the bubble may be clear, cloudy or hemorrhagic. Soon the bubbles are opened, exposing erosions of pink color, which subsequently dry out quickly with the formation of yellowish-brown crusts. After healing, pigmentation remains in place of the blisters. Sometimes there is an increase in the body temperature of the patient to subfebrile digits, malaise, which usually precede rash.
Elements of the rash that appear with problem are different from other manifestations of dermatoses. Erythematous spots in Duhring disease are rounded with clear boundaries, small size, and smooth surface. Papules and urticaropodibni eruptions can have a bizarre shape, scalloped edges with clear boundaries. As a rule, the rashes have a pink-red color. As a rule, with a mild course of dermatitis, Duhring is prescribed the intake of diamine-diphenylsulfone preparations - Dapsone, Avlosulphone, etc. In case of intolerance of these drugs, it is recommended to prescribe means containing sulfapyridine.
In severe disease, or if the therapy described above does not show results, the use of corticosteroids for oral administration is indicated. To remove the itch it is necessary to select antihistamines. External treatment of dermatitis herpetiformis is the use of aniline dyes, ointments containing corticosteroids. As a restorative means of vitamin therapy is shown, vitamin B12 is especially useful.
The diagnosis of dermatitis herpetiformis is established on the basis of the clinical picture, the presence of eosinophils in the blood near the contents of the vesicles, and a compression test with ointment containing potassium iodide (Jadasson’s test) helps to establish the correct diagnosis, after which rashes occur at the place of application of the ointment. The doctor should prescribe the sulfonic drugs, in severe forms and with ineffectiveness of the previous therapy. Corticosteroids are prescribed in the form of systemic therapy. Also the treatment includes vitamin preparations (vitamins of group B, mainly Cyanocobolamine, ascorbic and nicotinic acid, retinol, tocopherol), calcium preparations. Locally, solutions of aniline dyes (fucocine, methylene blue water solution), topical corticosteroids in the form of creams and ointments in combination with antimicrobial topical preparations are used. To relieve the itch, antihistamines are prescribed. On average, the treatment lasts 25-28 days. After completion of course, in order to achieve a long-term remission, the patient must strictly follow the doctor’s recommendations on the diet, with the exception of halogens in food products, and do not use iodine preparations internally or locally.
What can you do to treat it? Therapy is carried out only under the supervision of a dermatovenereologist. In the process of treatment, patients should observe a special diet, excluding products containing gluten, all sausages with bread fillers, and fish products, meat and poultry.
Prognosis and prevention of dermatitis herpetiformis:
Primary prophylaxis does not exist, and to prevent relapse, it is important for patients to strictly adhere to a gluten-free diet. The disease lasts for a long time, the periods of exacerbation alternate with remissions. In treating and eating healthy products, it is possible to reduce the frequency of relapses to a minimum.
