• Pruritic, blistering rash usually on extensor surfaces. • Most common in middle-aged white males, although may present in individuals of any age. • Immunoglobulin (Ig) A deposits in papillary skin; confirmed by immunofluorescence. • Asymptomatic “celiac” disease (gluten-sensitive enteropathy) in 75%-90% of patients. • Gluten: most important factor in DH is to eliminate all sources of gluten. Frazer’s criteria for diagnosing gluten-sensitive enteropathy (improvement on gluten-free diet and relapse after reintroduction) indicate rash and villous atrophy are largely gluten dependent. Gluten elimination improves virtually all patients, including disappearance of reticulin and gluten antibodies in DH. Gliadin polypeptide of gluten is key antigen; indirect immunofluorescence shows antibodies to gliadin in sera of 45% of DH patients. Titer and correlation increase with increasing disease severity. Approximately 81% of patients with severe jejunal abnormalities show antibodies to gliadin. Gluten connection is never
Dermatitis Herpetiformis
DIAGNOSTIC SUMMARY
THERAPEUTIC CONSIDERATIONS
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Dermatitis Herpetiformis
