DH 
DERMATITIS
HERPETIFORMIS

- a skin disorder

 
bullet Definition:
Dermatitis Herpetiformis (D.H.) is a chronic benign, skin disorder characterized by an intense burning and itching rash.
bullet Causes:
Genetic factors, the immune system, and a sensitivity to gluten, play a role in this disorder.  The precise details remain unknown.
bullet Characteristics:
A new unscratched lesion is red, raised, and usually less than 1 cm in diameter with a tiny blister at the centre.  However, if scratched, crusting appears on the surface.  The "burning" or "stinging" is different from a "regular" itch, and can occur 8-12 hours before a lesion appears.
bullet Areas Affected:
The most common areas are the elbows, knees, back of the neck and scalp, upper back, and the buttocks.  Facial and hair-line lesions are not uncommon; the inside of the mouth is rarely affected.  The rash has a symmetric distribution.
bullet Diagnosis:
Skin Biopsy from a lesion.
bullet Associated Gut Abnormality:
A small bowel biopsy of a person with D.H. will show the identical changes and intestinal damage as seen in Celiac Disease (gluten sensitive enteropathy).  However, the damage and symptoms experienced are less severe in D.H. than in Celiac Disease.  Often, persons with D.H. have no bowel complaints, but a small percentage may present with diarrhea, bloating, bulky stools, or abdominal cramps.  If bowel involvement is severe, the individual with D.H. may show evidence of malabsorption and malnutrition.
bullet Other Associated Conditions:
There is increased incidence of:
-pernicious anemia (vitamin B12 defiency)
-thyroid diseases
-lymphoma of the gut wall
bullet Management:
Treatment is by drugs and diet restrictions:
bullet Drugs:
Sulphones:
The response is dramatic.  Within 24-48 hours the burning is relieved and the rash starts to disappear.  The aim is to use the smallest dose possible to keep the itch and rash under control.
It has no effect on the gut abnormality.
bullet Diet:  Gluten Free Diet
Elimination of all wheat, rye, triticale, barley, oats, and any parts thereof from the diet will result in:
-the skin lesions improving
-the gut returning to normal
-a substantial reduction in or the elimination of the need for sulphones to control the skin rash
-a decreased risk of malignancy
bullet There is no cure:
More research is needed before all the questions can be answered about how D.H. develops and what the link is between the skin and the gut abnormalities.

More about DH here and a Medical lecture is Here.

 to Hamilton Chapter

 to Celiac Canada