DERMATITIS HERPETIFORMISGranular IgA is seen at the top of dermal papillae. So little detachments firstly appear on these areas and are filled by serous fluid. As a result of this phenomenon erythematous and edematous papules appear. Larger detachments lead to vesicle or blister formation in the later phases. Patients have severe itching. Two dermatoses with the most severe itching are dermatitis herpetiformis and scabies in dermatology.
Eosinophilia and iodine sensitivity support diagnosis but one can made diagnosis without these features. All of the patients have celiac disease, 75% of the patients show clinical symptoms, and in the 25% of the patients course of the disease is subclinical. Prognosis is good. Specific therapy with dapsone is successful. Therapy begins with 200 mg/day dapsone and gluten free diet in adults and then dapsone is tapered according to clinical cure. Gluten free diet lasts lifelong. |
The disease begins in young adolescents. Firstly erythematous and edematous
papules (mimicking urticaria), secondly grouped vesicles (mimicking herpes
simplex) appear. And then vesicles either transform pustules or blisters. Blisters
are rarely seen in dermatitis herpetiformis. Bleeding, crusting, excoriation and
secondary infection create a polymorphism because of severe scratching. In
this phase scabies can be thought in differential diagnosis. But there are not
family history and specific features of scabies in dermatitis herpetiformis.