<<Disclaimer: Verify this information before applying it to your situation.>>
 
In looking for more celiac web sites to add to my list of them (many more
have been added today), I came across the following. It is from a Hong Kong
site on skin disorders. This excerpt is from a page on blistering skin
disorders. They have a very different opinion over there about the
relationship between DH and celiac disease. Is it really different in the
Chinese? Don.
 
 
From: http://www.hkma.com.hk/std/blister.htm
 
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by Dr. C. N. Look
 
14. DERMATITIS HERPETIFORMIS
 
14.1 Introduction
 
An uncommon skin condition with the peak incidence around 30-40 years of
age. Male is more common than female.
 
14.2 Pathogenesis
 
In western countries, the disease usually associates with coeliac disease
(Gluten enteropathy). In Hong Kong, since coeliac disease is extremely rare,
this association is not usually observed.
 
14.3 Clinical Features
 
Lesions are composed of excoriated and scabbed intensely itchy papules.
 
The sites of predilection are extensors of 4 limbs, buttocks and face.
 
Intact vesicles seldom seen since they are ruptured by self scratching.
Lesions heal with no scarring.
 
14.4 Differential Diagnosis
 
(i) Scabies - Presence of burrows, other family members are affected and
sparing of the face are features suggestive of scabies.
 
(ii) Acute eczema - Atopic eczema affects flexures more than extensors.
 
14.5 Investigations
 
(i) Skin biopsy for histology - Microabscess in dermal papillae is
characteristic.
 
(ii) Direct Immunoflorescence - It shows granular IgA deposition in BMZ.
 
(iii) Screening for the presence of coeliac disease.
 
14.6 Treatment
 
(i) Dapsone - It is the drug of choice. After starting the treatment,
symptoms should subside within 48 hours and rash should be cleared up within
days. Side effects are haemolytic anaemia, methaemoglobulinaemia.
 
(ii) Sulphapyridine/sulphamethoxypyridazine
 
They are used when dapsone is contraindicated.
 
(iii) Gluten Free diet - It is useful only when the disease is associated
with coeliac disease. Referring to dietitian if required. Dietary
restriction is not easy to follow.
 
14.7 Prognosis
 
Spontaneous remission rate is low.