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Evelyn Loy <[log in to unmask]> asked:

>I was just wondering if someone could please send some info on HD. I have
>read some posts about it, but still don't know to much about it. Does it
>always show up as lesions? or could it show up as single pimple-like rash? I
>have been experiencing the rash and can't figure out where these little spots
>are comming from.

Are you referring to DH? If so, the following is from Peter Thompson's web
page at http://www.demon.co.uk:80/webguides/nutrition/diets/glutenfree/ and
was written by Joe Murray:

Dermatitis Herpetiformis


The following represents my views about this curious and very itchy
condition.

In general DH is a severely itchy skin condition that often starts
abruptly, affecting the elbows knees buttocks and scalp and the back. It
usually starts as little bumps that can become tiny blisters and then are
usually scratched off. It can occur in one spot only but usually occurs in
many differnt areas. The condition is related to the deposit under the skin
of IgA deposits. These occur in response to the ingestion of gluten in the
diet. However once deposited there, they are only slowly cleared by the
body even when the individual is gluten free. While most individuals with
DH do not have obvious GI symptoms almost all have some damage in their
intestine. They the potential for all of the nutritional complications of
celiac disease.

The diagnosis is made by taking a skin biopsy and preforming
immunoflorescence studies on it ( a specialised type of stain in major
laboratories) The test is usually reliable but it takes a signifigant
dedication to detect early cases where there is a short history of rash
rather than years or months of rash.

It is unusual to develope DH after the the start of a GFD for CD. About 5 %
of CD patients will develope DH usually in the first 6-12 months. This
probably reflects the long lasting nature of the deposits under the skin.

treatment for DH is 2 fold.

Remove the cause Gluten

suppress the skin response with drugs Dapsone or some other sulphones

The latter is the most common treatment used as it is rapidly relieves the
the itch. However there are some side effects associated with these
mediacations and they need to be taken under mediacal monitoring with blood
tests to detect side effects.

It is my practise that DH should be treated with a GFD for life and use of
drugs to get immediate relief in the short term. It is usually possible to
get pateint off the dapsone after several months of a strict GFD.

The most common complication of DH is scarring which ususally fades with
time. Occassionally there can be secondary infection from scratching. There
is probably a slightly increased chance of malignancy in DH not on a gfd
diet.

Several physical triggers are known to set off an attack of DH. especially
exposure to iodides and bromides which are contained in household cleaners.

A very good reference for DH is available from the GIG in washington.

Joe murray