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At 12:50 PM 6/16/95 -0700, Lauren Walton <[log in to unmask]> wrote:

>Can any of the list members enlighten me on Dermatitis
>Herpetiformis?

This is from a flyer (from several years back) that the Canadian Celiac
Association distributes:

A Skin Disorder

Definition:
Dermatitis herpetiformis (D.H.) is a chronic benign, skin disorder
characterized by an intense burning and itching rash.

Causes:
Genetic factors, the immune system, and a sensitivity to gluten play a part
in this disorder. The precise details remain unknown.

Incidence:
D.H. is not uncommon. It affects males and females equally and occurs in
about 1:100,000 people. It is more common in Caucasians than Blacks, and
rare in the Japanese population. Onset is most frequently in the late second
to the fourth decades in life.

Characteristics:
A new unscratched lesion is red, raised, and usually less than 1 cm in
diameter with a tiny blister at the center. However, if scratched, crusting
appears on the surface. The "burning" or "stinging" sensation is different
from a "regular" itch, and can often occur 8-12 hours before a lesion appears.

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 symmetric distribution.

Diagnosis:
Skin biopsy from a lesion.

Associated Gut Abnormality:
A small bowel biopsy of a person with D.H. will show identical changes and
intestinal damages as seen in Celiac Disease (gluten sensitivity
enteropathy). However, the damages 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.

Other Associated Conditions:
There is increased incidence of:
 - pernicious anemia (vitamin B12 deficiency)
 - thyroid disease
 - lymphoma of the gut wall

Management:
Treatment is by drugs, and diet restrictions:

Drugs: Dapsone (Avlosulfon) or related 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.

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

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 gut abnormalities.

Please direct further inquires to:

 Canadian Celiac Association
 6519B Mississauga Road
 Mississauga, Ontario L5N 1A6

 (905) 567-7195  (800-363-7296 in Canada)