Dermatitis herpetiformis (dermatitis herpetiformis Duhring; Dühring's disease) is an inflammatory skin disease associated with gluten enteropathy and characterized by polymorphic itchy rashes, a chronic recurrent course, and granular deposition of IgA in the dermal papillae.

Etiology and epidemiology

Dermatitis herpetiformis (DH) – a rare dermatosis, more often found in residents of Northern Europe.According to epidemiological studies conducted in Northern Europe, in different countries the incidence of HD ranges from 0.4 to 3.5 cases per 100,000 population per year, the prevalence – from 1.2 to 75.3 cases per 100,000 population.The disease usually begins at age 30 – 40 years, but can develop in childhood and old age.

Men get sick more often than women; The incidence ratio between men and women varies from 1.1:1 to 1.9:1.According to official state statistical observations, in 2014, the prevalence of HD in the Russian Federation was 2.0 cases per 100 thousand of the population aged 18 years and older, the incidence was 0.8 cases per 100 thousand of the population aged 18 years and older.Dermatitis herpetiformis, like gluten-sensitive enteropathy (celiac disease), is associated with the HLA-DQ2 and HLA-DQ8 haplotypes. Approximately 5% of patients with celiac disease develop HD.

Potential mechanisms for the development of HD in celiac enteropathy include the following:

• after eating and digesting food containing gluten, gliadin is formed, which is absorbed through the mucous membrane of the small intestine;
• gliadin is deaminated by tissue transglutaminase in the mucous membrane of the small intestine, covalent cross-links are formed between gliadin and transglutaminase;
• deaminated gliadin peptides bind to HLA DQ2 or HLA DQ8 molecules on antigen-presenting cells, where they are recognized by Th lymphocytes;
• activated Th lymphocytes produce proinflammatory cytokines and matrix metalloproteinases, which stimulate damage to the intestinal mucosa and the production of antibodies against tissue transglutaminase by B cells;
• the formation of an immune response against an endogenous antigen or multiple endogenous antigens develops due to its/their exposure during tissue damage and the production of IgA antibodies begins that can bind to epidermal transglutaminase;
• IgA antibodies to epidermal transglutaminase spread through the bloodstream, reach the skin, and bind to epidermal transglutaminase in the dermal papillae;
• the deposition of immune complexes in the dermal papillae stimulates the chemotaxis of neutrophils, which cause proteolytic cleavage of the basement membrane at the level of the lamina lucidum, leading to the formation of subepidermal blisters.

Classification

There is no generally accepted classification.

Symptoms of Dühring's disease

The sometimes observed monomorphism of rashes has made it possible to identify a number of clinical forms of HD:

• bullous;
• herpes-like;
• trichophytoid;
• strophulous.

The disease is characterized by a chronic relapsing course with alternation of relapses by periods of drug-induced or spontaneous complete remissions lasting from several weeks to several years. Spontaneous remissions are possible in 10 – 25% of patients.

HD is characterized by polymorphism, grouping and symmetry of lesions. The rashes are localized mainly on the extensor surfaces of the extremities, scalp, shoulders, knees, elbows, sacrum, buttocks, and are accompanied by itching. The rash consists of spots, blisters, papules and blisters of varying sizes. Tense blisters, with a dense covering, filled with transparent or cloudy, sometimes hemorrhagic contents, form on a hyperemic, edematous base. The blisters break open, forming erosions that quickly epithelialize, leaving hyperpigmentation. Sometimes skin damage is localized. Damage to the oral mucosa is rare. The general condition of the patients is satisfactory.

Diagnosis of Dühring's disease

The diagnosis is based on the analysis of anamnestic, clinical and laboratory data.
To make a diagnosis, the following laboratory tests are necessary:

• examination of the contents of blisters for eosinophilia;
• histological examination of a skin biopsy obtained from a fresh lesion containing a cavity (blister) reveals the subepidermal location of the cavity containing fibrin, neutrophilic and eosinophilic leukocytes;
• examination of a skin biopsy using direct immunofluorescence reveals granular deposits of class A immunoglobulin in the papillary layer of the dermis;
• blood serum testing using ELISA:
  • determination of the content of IgA antibodies to tissue transglutaminase in the blood;
  • determination of the content of IgA antibodies to endomysium in the blood.

To assess the general condition of the patient and identify diseases associated with HD, it is possible to conduct additional studies:

• biopsy of the small intestine (in rare cases, on the recommendation of a gastroenterologist);
• determination of malabsorption markers (iron levels, vitamin B12, folic acid in blood serum);
• Screening for other autoimmune diseases:
  • determination of the content of nonspecific antibodies in the blood: antibodies to thyroid peroxidase (found in approximately 20% of patients with HD) and to gastric parietal cells (in 10–25% of patients with HD), antinuclear antibodies;
  • testing to identify thyroid diseases (testing the level of thyroid-stimulating hormone (TSH), total triiodothyronine (T3) in the blood, total thyroxine (T4) in the blood serum);
  • typing for histocompatibility antigens type II (HLA II): DQ2, DQ

Differential diagnosis

Differential diagnosis is carried out with bullous pemphigoid, pemphigus vulgaris, linear IgA dermatosis, erythema multiforme, as well as atopic dermatitis, scabies, papular urticaria in children.

Lever's bullous pemphigoid differs from dermatitis herpetiformis in the absence of intense itching, grouping of blisters, and localization of rashes in the folds of the body. When examining skin biopsies of patients with bullous pemphigoid using direct immunofluorescence, class G immunoglobulins are detected along the basement membrane.

Pemphigus vulgaris. The first rash most often appears on the mucous membranes of the mouth, nose, pharynx and/or red border of the lips. Patients experience pain when eating, talking, or swallowing saliva. Characteristic signs are hypersalivation and a specific smell from the mouth. After 3–12 months, the process becomes more widespread with damage to the skin. Bubbles persist for a short time (from several hours to a day). On the mucous membranes, their appearance sometimes goes unnoticed, since the covers of the blisters are thin and quickly open, forming long-term, non-healing painful erosions. Some blisters on the skin may shrink into crusts. Erosion in pemphigus vulgaris is usually bright pink in color with a shiny, moist surface, tends to grow peripherally, generalization of the skin process is possible with the formation of extensive lesions, deterioration of the general condition, the addition of a secondary infection, the development of intoxication and death. One of the most characteristic signs of acantholytic pemphigus is Nikolsky's symptom - a clinical manifestation of acantholysis, which in pemphigus vulgaris can be positive both in the lesion and near it, as well as on apparently healthy skin far from the lesion.

With exudative erythema multiforme, along with spots and papules, vesicles, blisters, and blisters may appear. Blisters form on the mucous membranes, which open to form painful erosions. An edematous ridge forms along the periphery of the spots and/or edematous papules, and the center of the element, gradually sinking, acquires a cyanotic tint (symptom of “target”, or “iris”, or “bull’s eye”). Subjectively, the rash is accompanied by itching. The rashes tend to merge, forming garlands and arcs. The rash appears within 10–15 days and may be accompanied by a deterioration in the general condition: malaise, headache, fever. Then, over the course of 2–3 weeks, they gradually regress without leaving scars; in their place, pigmentation may be observed.

Treatment of Dühring's disease

Treatment goals:

• stopping the appearance of new rashes;
• epithelization of erosions;
• achieving and maintaining remission;
• improving the quality of life of patients.

General notes on therapy

The basis of therapy is a gluten-free diet, which leads to resolution of the skin process, elimination of enteropathy, disappearance of IgA antibodies to gliadin, endomysium and tissue transglutaminase.

The drug of choice for the treatment of patients with HD is dapsone. Dapsone therapy requires careful laboratory monitoring, especially liver and kidney function. Serious side effects may develop, especially hemolysis. Severe hypersensitivity syndrome may also develop.

If adverse events occur during dapsone therapy or its ineffectiveness, sulfasalazine may be prescribed. During therapy with sulfasalazine, hypersensitivity reactions, hemolytic anemia, proteinuria and crystalluria may occur. To monitor adverse effects of drug therapy, a clinical blood test and a general urine test are prescribed, which are carried out before starting therapy and monthly for the first 3 months, then once every 6 months. The most common adverse events of sulfasalazine therapy – nausea, vomiting and lack of appetite – are prevented by the administration of enteric forms of the drug.

Systemic glucocorticosteroid drugs are ineffective.

Diet for Duhring's disease

Wheat, barley, rye, oats and other grains should be completely eliminated from the diet. It is also necessary to exclude foods containing iodine (seafood, feijoa, persimmon, etc.).

A gluten-free diet results in regression of the rash after 1–2 years, but dermatitis herpetiformis invariably recurs within 12 weeks of reintroduction of gluten into the diet, requiring patients to adhere to the diet for life. Only 10–20% of patients develop immune tolerance and are able to maintain a regular diet after several years of a strict gluten-free diet; this is most often observed in cases of childhood onset and in patients treated with dapsone.

Strict adherence to a gluten-free diet over the long term leads to a reduction in the need for medications, a reduced risk of developing intestinal lymphomas, and resolution of skin rashes and symptoms of enteropathy/malabsorption.

Treatment methods for Dühring's disease:

Systemic therapy

• dapsone
• sulfasalazine

Antihistamines

Antihistamines may be used to control itching, alternating every 10 days as needed:

• clemastine 1 mg
• chloropyramine 25 mg
• loratadine 10 mg
• mebhydrolin 50–200 mg

For severe itching, parenteral administration of antihistamines is indicated:

• clemastine 2 mg
• chloropyramine 20–40 mg

External therapy

Glucocorticosteroid drugs

Topical glucocorticosteroid drugs can be used for severe itching to reduce it:

• clobetasol propionate 0.05% ointment, cream
• triamcinolone 0.1% ointment
• betamethasone 0.01% ointment

Treatment of bubbles and erosions:

The area of ​​blisters and erosions is treated with a solution of aniline dyes, and in the presence of a secondary infection - with aerosols containing glucocorticosteroids and antibacterial drugs. Antiseptic rinse solutions are applied to erosions in the area of ​​the oral mucosa.

Special situations

Dühring's disease - treatment for children

Indications for hospitalization

• lack of effect from treatment carried out on an outpatient basis;
• the appearance of new rashes;
• the presence of secondary infection in the lesions.

Requirements for treatment results

• regression of rashes;
• epithelization of erosions;
• disappearance of itching.

Tactics in the absence of treatment effect

If there is no effect from dapsone therapy at a dosage of 1 mg per kg of body weight per day, the dosage of the drug can be increased to 150-200 mg per day for a short course or oral sulfasalazine therapy can be prescribed.

Prevention of Dühring's disease

Primary prevention of dermatitis herpetiformis has not been developed. A secondary prevention measure is adherence to a gluten-free diet in patients with dermatitis herpetiformis and gluten enteropathy (celiac disease).

IF YOU HAVE ANY QUESTIONS ABOUT THIS DISEASE, CONTACT DOCTOR DERMATOVENEROLOGIST KH.M. ADAEV:

WHATSAPP 8 989 933 87 34

EMAIL: [email protected]

INSTAGRAM @DERMATOLOG_95

Dermatitis herpetiformis (Dühring's dermatitis) is a chronic skin disease. It manifests itself as redness and swelling of certain areas of the skin, a rash in the form of blisters, blisters and papules, accompanied by burning and itching. Dühring's dermatitis is called herpetic because the rash is grouped in exactly the same way as with herpes. In order to identify the disease, a histological examination and analysis of the contents of the vesicles using direct immune fluorescence is prescribed. For treatment, drugs from the group of sulfones and corticosteroids are used.

Features of Dühring's dermatitis

The risk group for this disease has not been determined; dermatitis herpetiformis occurs in patients of any age and gender. But most often it is diagnosed in middle-aged men. In some cases, this is a skin reaction to a malignant tumor, that is, a para-oncological form. But more often the cause of the disease is factors typical for dermatological diseases. What the areas of skin affected by Dühring's dermatitis look like can be seen in the photos below.

This type of dermatitis differs from most dermatological diseases in the variety of rashes. Blisters and papules, vesicles and spots can be observed on the skin at the same time.

Characteristic signs of Dühring's dermatitis:

• Stains. They appear first, have clear contours and a smooth surface, and in their place blisters, papules and vesicles form.
• Blisters. After 3-4 days they burst, after a while they become covered with crusts.
• Papules. Small seals of a bizarre shape with bright red borders.
• Bubbles. They are filled with a clear (sometimes cloudy) liquid and have a diameter of 2 to 20 mm.

Rashes are observed on the shoulders, elbows, lower back, buttocks and legs, and very rarely on the mucous membrane of the mouth. The affected areas are symmetrical, the skin may not change in appearance, but may become swollen or reddened. The disease also has general symptoms. These are weakness and slight tingling in the area of ​​the rash, severe itching and burning, a slight increase in temperature and loose stools, insomnia or drowsiness, disruption of the thyroid gland and other organs.

Causes of Dühring's dermatitis

The causes of Dühring's dermatitis have not yet been established; the disease is considered unpredictable. The main factors that provoke the disease are similar to those that cause other dermatological diseases. This:

• Genetic predisposition.
• Weak immune defense.
• Viral infections.
• Pregnancy.
• Hormonal imbalances.
• Stress, excessive mental stress.
• Intolerance to products containing gluten.
• Presence of cancer cells in the body.
• Disruption of the gastrointestinal tract.
• Worms.

Despite the factors identified, most doctors believe that Dühring's dermatitis herpetiformis belongs to autoimmune pathologies (diseases associated with dysfunction of the immune system).

Dühring's dermatitis in children

Most often, the disease is diagnosed in male patients aged 15 to 60 years, women get sick less often, children - in exceptional cases. Typically, it is an itchy rash that quickly spreads throughout the body. Dermatitis herpetiformis in children develops for the same reasons as in adults, is accompanied by the same symptoms, and is treated with the same drugs. If a child develops symptoms of dermatitis, you should contact a pediatrician or dermatologist as soon as possible, who will prescribe the necessary tests for diagnosis and treatment.

In order to confirm the diagnosis, an external examination is not enough. Therefore, the doctor prescribes a number of studies:

• Clinical blood test.
• Examination of fluid from bubbles and blisters.
• Histology.
• Examination of the skin using the immunofluorescence method.
• Biopsy.
• Thyroid examination.

The most accurate method is considered to be the Jadassohn test (for sensitivity to iodine). The Jadassohn test is named after the German doctor who developed this method. It consists of the following: a compress with ointment based on potassium iodide is applied to the skin area. If after a day rashes or redness appear at the site of the compress, it can be said that the patient has dermatitis herpetiformis.

Treatment of Dühring's dermatitis

Treatment of Dühring's dermatitis in adults is a set of measures that combines medication and a gluten-free diet. Most gluten is found in cereals, so baked goods and pasta, porridge based on wheat, rye, oats and barley, legumes, cabbage, kvass, coffee, beer, and desserts are excluded from the diet. If the disease proceeds without complications, the doctor prescribes medications from the sulfone group - Sulfapyridine, Diucifon or Dapsone. If the course of the disease is more severe, corticosteroid drugs are prescribed - Dexamethasone, Prednisolone or Methylprednisolone. In order to reduce itching, take antihistamines - Claritin, Citrine or Erius, to strengthen the body - vitamin complexes - Neurovitan, Supradin or Vitrum.

In addition to tablets, topical agents are used - the rash is treated with fucorcin or methylene blue, hormonal ointments, suspensions, and sprays are used. To relieve inflammation, apply compresses with a solution of potassium permanganate.

Folk remedies are used as additional treatment:

• St. John's wort oil. Grind 30 g of St. John's wort leaves and flowers, pour in 200 ml of vegetable oil. Leave to infuse for 1.5-2 weeks. Filter, lubricate the affected areas of the skin 2-3 times a day.
• St. John's wort based ointment. Boil St. John's wort juice in a water bath until thickened, let cool. Mix with butter in a ratio of 1:4. The ointment softens the skin, heals wounds, disinfects and destroys germs.
• Decoction of birch buds. Pour 1 cup of birch buds into 300 ml of water, put on fire, and bring to a boil. Keep on fire for 15 minutes, let cool, strain. Wipe the rash areas 3-5 times a day. The decoction soothes, relieves itching and inflammation.
• Tea with lemon balm. Brew 1-2 teaspoons of lemon balm in 200 ml of boiling water, let cool. You can drink it at any time, 2-3 times a day, after meals instead of tea. The product has anti-inflammatory and restorative properties.

A doctor should select a treatment regimen and prescribe medications; self-medication can lead to secondary infection and dermatitis becoming severe.

Complications of Dühring's dermatitis

To ensure that dermatitis herpetiformis does not cause complications, the doctor monitors the progress of treatment and periodically prescribes tests. In some cases, the disease is accompanied by nausea and vomiting; in severe cases, hospital treatment is required. If this does not happen, dermatitis will develop into a more dangerous form for health, and the risk of contracting a secondary infection will increase significantly. Acute periods will alternate with remission, which lasts for several months. The patient will suffer from itching and burning, and his skin will take on a repulsive appearance. The person will worry about his appearance, reduce communication to a minimum, and lose sleep and appetite. The result is mental health problems and prolonged depression.

Prevention of Dühring's dermatitis

Dühring's dermatitis in adults is a chronic disease; complete recovery is observed in exceptional cases. If you are predisposed to the disease, follow these simple rules:

• Follow a gluten-free diet.
• Avoid foods high in iodine.
• Take iodine-containing medications under medical supervision.
• Ensure yourself proper rest and healthy sleep.
• Take regular walks in the fresh air.
• Avoid stress, overheating and hypothermia.
• Lead a healthy, active lifestyle.

Unfortunately, Dühring's dermatitis is often accompanied by severe relapses, especially dangerous for older people. But it is impossible to predict the course of the disease and the course of treatment. Only a timely visit to a dermatologist, complex therapy and compliance with the doctor’s recommendations will allow you to get rid of the disease and return to a full life. The disease is difficult to treat, so it requires a lot of patience and a positive attitude.

Dermatitis herpetiformis (Dühring's disease) is a chronic skin disease that recurs at any age. The disease manifests itself as an erythematous and polymorphic rash with severe itching.

Duhring's dermatitis got its name from the famous dermatologist Duhring, who lived in Philadelphia in 1884. It cannot be called a rare disease, since it occurs in all age categories. However, men are predominantly affected by the disease.

It is worth noting that the disease is characterized by a chronic course that can last 20 or even 30 years. Long-term remissions are replaced by exacerbations.

Adequate treatment leads to a gradual decrease in symptoms, and a longer period of remission is noted. The following pattern is noted: if the disease appeared in childhood, in most cases it goes away spontaneously in adolescence.

Photo

Reasons

To date, the exact causes of the development of dermatitis duhring herpetiformis have not been established. It is assumed that the disease is autoimmune in nature. It is also believed that a hereditary factor is largely to blame.

In support of this, dermatologists have found that the majority of patients with dermatitis herpetiformis have a non-inflammatory disease of the intestinal system (gastritis). In addition, an important role in the development of the disease belongs to the body's excessive sensitivity to iodine.

Symptoms

Most often, the disease manifests itself in the form of blisters filled with clear liquid.

Duhring's dermatitis herpetiformis begins with poor health and the appearance of small formations of a polymorphic rash. The patient's body temperature may rise and a tingling sensation may appear. The rash can affect any part of the body except the palms and soles of the feet. The most affected areas are the extensor areas of the body, the buttocks, and lower back. Often the rash is accompanied by itching and burning.

The rash occurs in various forms: blisters, nodules, spots, papules and others.

Externally, the rash is very similar to herpes. It is for this criterion that the disease is called dermatitis herpetiformis (herpetic). The bubbles remain in the same state for 3-4 days. Then the rash begins to burst spontaneously, forming erosions.

Dühring's disease is usually divided into the following forms:

• vesicular;
• papular;
• bullous:
• urticariform.

Spots with dermatitis herpetiformis are characterized by a round shape, small size with clear edges. Papules can have a variety of bizarre shapes. As a rule, the rashes have a smooth surface.

The bubbles are characterized by their smaller size with a dense top. Inside the bubbles there is a clear liquid that becomes cloudy over time. If an infection is attached to the vesicles, the contents take on a purulent form.

Usually the blisters spontaneously open on the 4th day, forming a weeping erosion. No peripheral growth of bubbles is observed. Further, the erosions become covered with crusts, which, after falling off, can form spots.

Diagnostic methods

Diagnosis of dermatitis herpetiformis involves a thorough examination of the symptomatic manifestations of the disease. By what clinical manifestations can this disease be identified:

• varied rash;
• grouping of bubbles;
• cyclical development of the disease;
• high sensitivity to iodine and iodine-containing drugs;
• a small percentage of eosinophilia in the vesicular fluid.

To establish an accurate diagnosis of the disease, the following tests are performed:

1. Analysis for the presence of eosinophilia in the blood and vesicular fluid.
2. Iodine test (Jadasson test). The test is as follows: a certain amount of ointment containing iodine is applied to the skin, and a 5% solution of potassium iodide is taken orally. The test is considered positive if signs of skin reactions are detected.

In severe cases of the disease, an internal iodine test is not performed, as this can cause an acute exacerbation.

It is important to distinguish Dühring's dermatitis herpetiformis from the following diseases:

• pemphigus vulgaris;
• erythema multiforme;
• bullous pemphigoid.

Treatment

Therapy for mild Dühring's disease involves taking:

• Diamino-diphenylsulfone drugs (Dapsone).
• Drugs containing sulfapyridine (prescribed for intolerance to the above drugs).

Treatment of severe disease involves taking the following medications:

• oral corticosteroids;
• taking antihistamines (to relieve itching).

To generally strengthen the immune system, vitamin therapy is prescribed, in particular vitamin B12.

Food	Allowed	Prohibited
Bread and bakery products	Baking and bread made from corn, rice flour, and also containing starch.	Bakery products made from wheat, barley, rye flour.
Meat, fish, dairy products	Meat, fish, poultry, milk and fermented milk products, except yogurt.	Sausages, products with bread and meat (dumplings, pasties, etc.).
Vegetables	All vegetables, except cereals, legumes, cabbage.	Peas, beans, cabbage, cereal plants.
Cereal dishes	Dishes made from rice, corn, buckwheat.	Dishes made from semolina, pearl barley, pasta, noodles.
Soups	Vegetable soups, broths, puree soup.	Soups made from peas, lentils, beans.
Fruits	Any	Without exception
Drinks	Still mineral water, tea, coffee.	Kvass, beer, coffee drinks containing oats, barley.

Traditional medicine methods

A decoction based on medicinal herbs will help relieve inflammation.

Good results in the treatment of dermatitis herpetiformis are shown by the use of herbal remedies that have anti-inflammatory and antihistamine effects.

What herbs can be used as herbal remedies:

• calendula;
• juniper;
• knotweed;
• mistletoe;
• licorice;
• sea ​​​​buckthorn.

Duhring's dermatitis herpetiformis develops in the body over a long period of time, alternating with remissions. Adequate treatment and a properly selected menu reduce the frequency of relapses and prolong the period of remission.

Content

The appearance of numerous, itchy, transparent blisters on the body requires immediate contact with specialists. What are the prognosis for the patient for the development of Dühring's dermatitis, why is the drug Dapsone used to treat the disease - questions, the answers to which are important for the patient. You should know preventive measures, treatment features, medications, and diet specifics.

What is Dühring's dermatitis?

External manifestations of dermatitis are unpleasant in appearance, causing a feeling of danger and the possibility of infection. Rashes on the body do not pose a threat to others. Dühring's dermatitis is a skin disease that belongs to the group of autoimmune diseases. Its exact cause is not known; the process can begin at any age. More often the disease is detected in men between 20 and 40 years old. Dermatitis is characterized by the appearance of entire groups of bubbles and blisters, which can form:

• rings;
• garlands;
• half rings

Dühring's disease is characterized by a chronic, protracted course, paroxysmal appearance of an itchy rash on the body and limbs. The blisters are similar to the symptoms of herpes, which is why its other name is dermatitis herpetiformis. Clinical rashes with Dühring's disease differ in appearance:

• Erythematous red spots with dilated capillaries, have a round shape, clear boundaries.
• Blisters - appear when elements are filled with liquid from vessels. As the size increases, individual spots merge into large lesions.

Severe itching provokes scratching of the areas and the appearance of crusts on top of the blisters. Herpetic dermatitis is characterized by the formation of vesicles. These are cavities above the surface of the skin, filled with liquid, reaching sizes up to 20 mm. When dermatitis becomes infected, lumps of blood appear, the contents thicken and become cloudy, and upon opening, erosive tissue is visible.

Symptoms

The main signs of the disease - rashes - burst when scratched, the liquid gets onto the healthy surface of the skin, forming new lesions. The following symptoms are observed with dermatitis:

• severe itching;
• soreness;
• gastrointestinal problems;
• fatty gray stool;
• the appearance of ulcers;
• tissue ulceration;
• crust formation.

Herpetic vesicular dermatitis spreads throughout the body, typical locations are on the elbows, in the flexion areas of the forearms, and on the face. The disease does not appear on the feet or palms. Consider the symptoms:

• nervousness;
• deterioration of health;
• the appearance of nagging pain in the joints;
• lethargy;
• allergic signs - runny nose, swollen tissues;
• weakness;
• changes in body temperature;
• worsening mood due to dietary restrictions;
• psychological problems;
• depressive state.

Reasons

The exact origin of Dühring's disease is unknown to medicine. Experts believe that genetic predisposition is the likely cause of dermatitis. It is worth noting the factors causing Dühring’s disease:

• weakened immunity;
• dysfunction of absorption in the intestines;
• sensitivity to cereal protein – gluten;
• pathologies of the endocrine system;
• inflammatory processes of the gastrointestinal tract.

Among the causes of dermatitis, high sensitivity to iodine preparations is considered. The development of the disease can be triggered by:

Diagnostics

It is necessary to visit a doctor if signs of illness appear. Early diagnosis helps to quickly obtain a therapeutic effect and alleviate the patient’s condition. For an objective result, several laboratory procedures must be performed. Diagnostic methods for determining dermatitis include:

• complete blood count to determine the number of eosinophils;
• cytological study of the contents of blisters;
• thyroid function testing;
• histological examination of inflamed skin.

Direct immunofluorescence is used as a rapid diagnosis of Dühring's disease. This is a hardware test that detects the accumulation of immunoglobulins A. One of the main tests that diagnoses Dühring's dermatosis is the Jadassohn test, which measures the body's susceptibility to iodine. The procedure is carried out as follows:

• apply a compress with ointment containing potassium iodide to the forearm area;
• after 24 hours the result is checked - rashes and redness show a positive test.

Treatment of Dühring's dermatitis

After diagnosis, patients are examined for the presence of malignant neoplasms and gastrointestinal pathologies. Since the disease has a chronic course, dermatologists are faced with the following tasks:

• transfer dermatitis into a stage of long-term remission;
• relieve the patient from external manifestations so that he feels comfortable physically and psychologically;
• eliminate rashes so as not to provoke infection;
• show and tell methods of preventing Dühring's dermatosis.

To obtain the best effect of treating dermatitis, the patient is required to follow simple rules:

• do not take baths;
• exclude visiting the bathhouse;
• wash in the shower without using soap or a washcloth on the affected areas;
• Sleep duration should be at least 8 hours;
• take long walks;
• avoid stressful situations;
• do not overload physically;
• follow a diet;
• take vitamins, ascorbic acid.

Drug therapy for Dühring's dermatosis includes the use of drugs that solve various problems. Dermatologists prescribe medications:

• antihistamines - remove signs of allergies, eliminate itching - Suprastin, Claritin;
• sedatives - calming - Persen, natural preparations - Motherwort, Valerian;
• hormonal agents for severe forms - Prednisolone, Triamcinolone;
• for external use - lubricate the skin with Fukortsin liquid, brilliant green solution, salicylic acid, ointments.

The main effect in the treatment of Dühring's dermatitis is exerted by drugs of the sulfone group. The use of the drug Dapsone has a good effect. When assigning, take into account:

• admission 5 days;
• break - two days;
• carry out at least 5 cycles;
• dosage – 100 mg twice a day;
• after the symptoms disappear, a maintenance measure is 5 mg twice a week;
• contraindications – incompatibility with barbiturates, amidopyrine.

Ointment

Ointments that are effective in the treatment of psoriasis and eczema help to quickly heal wounds and relieve unpleasant symptoms. The drugs have a disinfectant, anti-inflammatory, antipruritic, and drying effect. Popular ointments for dermatitis:

• Dermatol;
• Zinc;
• Naftalanaya;
• corticosteroid – Celestoderm;
• antihistamine – Suprastin;
• non-steroidal anti-inflammatory – Bufexamac.

Diet for dermatitis

The main task of organizing proper nutrition for Dühring's disease is to exclude foods containing iodine and glutens. It is required to give up grains - barley, wheat, rye, and all dishes and products that contain them. For dermatitis, you need to remove from your diet:

• flour products;
• coffee substitutes;
• pasta;
• kvass;
• chocolate;
• beer;
• sausage containing bread ingredients;
• breaded dishes;
• ice cream;
• sea ​​fish;
• mussels;
• shrimps;
• caviar;
• lobsters;
• seaweed.

In the diet for Dühring's dermatitis, it is considered useful to diversify the diet:

• fruits;
• nuts;
• greens;
• spices;
• olives;
• homemade mayonnaise;
• onions, garlic;
• beekeeping products;
• potatoes;
• zucchini;
• carrots;
• beets;
• compotes;
• natural coffee;
• jelly;
• vegetable oil, butter; sunflower seeds;
• buckwheat, rice, corn porridge.

Prevention

Unfortunately, it is not possible to completely get rid of Dühring's disease, but it is possible to forget about it for a long time. To do this, it is necessary to pay attention to the prevention of dermatitis herpetiformis. To exclude cases of relapse, you should follow the dermatologist's instructions:

• strictly follow a diet;
• exclude medications containing iodine;
• be registered with a dispensary.

Preventive measures for Dühring's disease - dermatitis - include:

• exclusion of diagnostic studies using iodine-containing substances;
• maintaining hygiene;
• avoiding hypothermia and overheating;
• reducing fat intake;
• elimination of stress;
• elimination of foci of infection in the body;
• taking Dapsone as prescribed by the doctor.

Photo of Dühring's dermatitis herpetiformis

Attention! The information on the site cannot be used as a basis for making a diagnosis or starting self-medication! No website can replace a visit to a doctor. Do not self-medicate based on information on the Internet, it is dangerous!

Dermatitis herpetiformis, called Dühring's dermatitis in medical circles, is a rather complex skin disease that has a chronic course.

Most often it manifests itself in the form of specific rashes on certain parts of the body and severe itching.

Treatment of this skin disease includes a set of measures, ranging from drug therapy to adherence to a special diet.

Dermatitis herpetiformis most often develops in adults, and the disease is most often diagnosed in men after thirty years of age.

However, this does not mean that women cannot get this skin disease.

A characteristic feature of this complex pathology is that during its course it alternates with periods of relapses and remissions.

It should also be noted that the nature of this disease has not yet been precisely established; there are only certain assumptions.

This disease is characterized by symptoms in the form of erythematous spots, blisters and papules, which can be located throughout the body. In this case, the patient almost always experiences a feeling of severe itching and burning.

Dermatitis herpetiformis has some similarities with herpes rashes, but only visually.

To diagnose Dühring's dermatitis, it is necessary to undergo a special histological examination.

In addition, if the development of this skin disease is suspected, an analysis of the internal contents of the blisters and a study of the body’s reaction to direct immunofluorescence are often prescribed.

Meanwhile, treatment of this type of dermatitis requires the use of drugs belonging to the sulfone group, as well as some types of corticosteroids.

It should be noted that representatives of the stronger half of humanity are most susceptible to Dühring's dermatitis.

In some cases, this skin disease is a kind of reaction of the skin to the development of a malignant tumor inside the body.

Laboratory methods have established that severe intoxication of the body contributes to the development of the disease, as well as certain types of vaccinations, which can lead to a weakening of the immune system as a whole.

Dermatitis can make itself felt during nervous and physical exhaustion.

People who have been diagnosed with dermatitis often have excessive sensitivity to iodine and similar chemical elements.

Many medical experts believe that various types of allergic reactions contribute to the development of Dühring's dermatitis. There is also an assumption about the viral nature of the development of dermatitis herpetiformis.

Treatment of this complex disease should be carried out under the strict supervision of the attending physician.

Therapy should include a set of measures aimed at improving the condition of the skin, as well as eliminating the main cause that led to the development of this type of dermatitis.

Symptoms and course

Symptoms of Dühring's dermatitis appear in stages. At the very beginning of the disease, a person feels severe weakness and a general deterioration in health.

During this period, there is a sharp increase in temperature, itching and an unpleasant tingling sensation throughout the body. Subsequently, symptoms begin to appear sharply.

A rash in some areas forms almost instantly, and a person may feel a strong burning sensation.

Quite quickly, in places where the rash forms on the body, watery blisters begin to form, containing liquid contents inside.

With Dühring's dermatitis, the rash can appear on almost any part of the skin, with the exception of the palms and soles of the feet. Most often, watery formations form in the back, shoulders, lower back and buttocks.

At the very beginning of the disease, the liquid contents of the rash are transparent, but over time it gradually begins to become cloudy.

Severe itching in the area of ​​​​the formation of the rash leads to the fact that a person begins to scratch the affected areas, as a result of which dermatitis progresses.

Dermatitis herpetiformis is classified as a polymorphic disease that is characterized by varying sizes, shapes and structures of rashes that appear on the skin.

In some cases, formations on the skin resemble a nettle burn.

Currently, there are several forms of dermatitis of this type, namely:

1. papular;
2. vesicular;
3. bullous;
4. urticariform.

A characteristic feature of this type of dermatitis is the appearance of red swelling in various areas of the skin.

In addition to the main signs in the form of various rashes on the body, symptoms of this disease also include weakness, sleep disturbances, and malfunction of the thyroid gland.

Dühring's dermatitis has a long and at the same time chronic course. Very often there are no symptoms of the disease for several months, but after some time the disease reappears.

This type of dermatitis can also occur in pregnant women. In this case, the third month of pregnancy is considered a dangerous period.

Basic therapy

Treatment of this type of skin disease is based on the simultaneous use of drug therapy and a gluten-free diet.

If the disease is mild, then treatment includes drugs of the sulfone group. Severe forms of the disease require more complex therapy.

In addition, to alleviate the patient's condition, he may be prescribed certain types of antihistamines.

It is recommended to treat all rashes that are observed on the skin with brilliant green, as well as fucorcin.

The use of certain types of ointments and creams intended for external use is also allowed. Strengthening treatment should also be carried out simultaneously with the main therapy.

In this case, you should pay attention to vitamin C and B vitamins, especially folic acid.

It is extremely important to strictly adhere to a special diet during the treatment of dermatitis.