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Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.

Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC - An Bras Dermatol (2014 Nov-Dec)

Bottom Line: These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur.Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative.Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

View Article: PubMed Central - PubMed

Affiliation: West ParanĂ¡ State University, Cascavel, PR, Brazil.

ABSTRACT
Researches on DH have shown that it is not just a bullous skin disease, but a cutaneous-intestinal disorder caused by hypersensitivity to gluten. Exposure to gluten is the starting point of an inflammatory cascade capable of forming autoantibodies that are brought to the skin, where they are deposited, culminating in the formation of skin lesions. These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur. Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative. Patients who follow gluten-free diets have better control of symptoms on the skin and intestine, as well as lower risks of progression to lymphoma. Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

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Related in: MedlinePlus

cutaneous lesions in a patient with DH: A. Vesico-bullous lesions inlower limbs; B. Grouped vesicles on an eryt- A B hematous base
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f02: cutaneous lesions in a patient with DH: A. Vesico-bullous lesions inlower limbs; B. Grouped vesicles on an eryt- A B hematous base

Mentions: Lesions tend to grow in a centrifugal pattern, with vesicles predominating in theperiphery (Figures 2A and 2B). The intense pruritus is not related to the extent of diseaseand promotes the loss of the herpetiform aspect due to multiple abrasions. The diseasetends to evolve with periods of remissions, and there is not an efficient method tomeasure its activity. For this purpose, some studies used the number of lesionspresented by the patient and the dose of suppressive medication administered at thetime.3,15


Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.

Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC - An Bras Dermatol (2014 Nov-Dec)

cutaneous lesions in a patient with DH: A. Vesico-bullous lesions inlower limbs; B. Grouped vesicles on an eryt- A B hematous base
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230654&req=5

f02: cutaneous lesions in a patient with DH: A. Vesico-bullous lesions inlower limbs; B. Grouped vesicles on an eryt- A B hematous base
Mentions: Lesions tend to grow in a centrifugal pattern, with vesicles predominating in theperiphery (Figures 2A and 2B). The intense pruritus is not related to the extent of diseaseand promotes the loss of the herpetiform aspect due to multiple abrasions. The diseasetends to evolve with periods of remissions, and there is not an efficient method tomeasure its activity. For this purpose, some studies used the number of lesionspresented by the patient and the dose of suppressive medication administered at thetime.3,15

Bottom Line: These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur.Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative.Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

View Article: PubMed Central - PubMed

Affiliation: West ParanĂ¡ State University, Cascavel, PR, Brazil.

ABSTRACT
Researches on DH have shown that it is not just a bullous skin disease, but a cutaneous-intestinal disorder caused by hypersensitivity to gluten. Exposure to gluten is the starting point of an inflammatory cascade capable of forming autoantibodies that are brought to the skin, where they are deposited, culminating in the formation of skin lesions. These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur. Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative. Patients who follow gluten-free diets have better control of symptoms on the skin and intestine, as well as lower risks of progression to lymphoma. Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

Show MeSH
Related in: MedlinePlus