RT Book, Section
A1 Shinkai, Kanade
A1 Fox, Lindy P.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1193628729
T1 Dermatitis Herpetiformis
T2 Current Medical Diagnosis & Treatment 2023
YR 2023
FD 2023
PB McGraw-Hill Education
PP New York, NY
SN 9781264687343
LK accessmedicine.mhmedical.com/content.aspx?aid=1193628729
RD 2024/09/15
AB Dermatitis  herpetiformis  is  an  uncommon  disease  manifested  by  intensely  pruritic  papules,  vesicles,  and  papulovesicles  mainly  on  the  elbows,  knees,  buttocks,  posterior  neck,  and  scalp  (eFigure  6–89).  It  has  the  highest  prevalence  in  Northern  Europe  and  is  associated  with  HLA  antigens  -B8,  -DR3,  and  -DQ2.  The  histopathology  is  distinctive.  Circulating  antibodies  to  tissue  transglutaminase  are  present  in  90%  of  cases.  NSAIDs  may  cause  flares.  Patients  may  have  gluten-sensitive  enteropathy.  Three-fourths  of  patients  have  villous  atrophy  on  small  bowel  biopsy;  however,  GI  symptoms  are  subclinical  in  most.  The  prevalence  of  dermatitis  herpetiformis  to  celiac  disease  is  1:8.  Ingestion  of  gluten  is  the  cause  of  dermatitis  herpetiformis,  and  strict  long-term  avoidance  of  dietary  gluten  may  eliminate  the  need  for  treatment  or  decrease  the  dose  of  dapsone  (initial  treatment  dose  is  100–200  mg  orally  daily)  required  to  control  the  disease.  Patients  with  dermatitis  herpetiformis  are  at  increased  risk  for  GI  lymphoma,  and  this  risk  is  reduced  by  a  gluten-free  diet.