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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

Diagnostic methods in DH: A. Skin histopathology showingsubepidermal blister with neutrophilic infiltrate in the papillary dermis;B. Direct immunofluorescence of skin fragment showing IgAdeposits along the dermoepidermal junction and on top of the dermal papillae.The image is a courtesy from Dr. Carlos Floriano de Moraes; B The image is acourtesy A B from Dr. Valeria Aoki
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f04: Diagnostic methods in DH: A. Skin histopathology showingsubepidermal blister with neutrophilic infiltrate in the papillary dermis;B. Direct immunofluorescence of skin fragment showing IgAdeposits along the dermoepidermal junction and on top of the dermal papillae.The image is a courtesy from Dr. Carlos Floriano de Moraes; B The image is acourtesy A B from Dr. Valeria Aoki

Mentions: Edema with the formation of fissures or microvesicles on top of the dermal papillaeoccurs later. Collagen is degraded resulting in detachment of the epidermis. Multiplevesicles may coalesce forming unilocular blisters, clinically translated asvesicobullae in typical locations (Figure4A).1,3


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)

Diagnostic methods in DH: A. Skin histopathology showingsubepidermal blister with neutrophilic infiltrate in the papillary dermis;B. Direct immunofluorescence of skin fragment showing IgAdeposits along the dermoepidermal junction and on top of the dermal papillae.The image is a courtesy from Dr. Carlos Floriano de Moraes; B The image is acourtesy A B from Dr. Valeria Aoki
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f04: Diagnostic methods in DH: A. Skin histopathology showingsubepidermal blister with neutrophilic infiltrate in the papillary dermis;B. Direct immunofluorescence of skin fragment showing IgAdeposits along the dermoepidermal junction and on top of the dermal papillae.The image is a courtesy from Dr. Carlos Floriano de Moraes; B The image is acourtesy A B from Dr. Valeria Aoki
Mentions: Edema with the formation of fissures or microvesicles on top of the dermal papillaeoccurs later. Collagen is degraded resulting in detachment of the epidermis. Multiplevesicles may coalesce forming unilocular blisters, clinically translated asvesicobullae in typical locations (Figure4A).1,3

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