Dermatitis herpetiformis is a chronic pruritic erosion manifested by grouped vesicles with a particular propensity to the extensor surfaces, lower back, and scalp.
The eruption is mediated by IgA, which is deposited along the basement membrane. The eruption is symmetrical, and lesions can range from small urticarial papules through vesicles to frank bullae.
Dermatitis herpetiformis is associated with a gluten enteropathy, and is therefore occasionally associated with the late development of intestinal lymphoma.
- Dapsone 100 mg/day can provide dramatic relief of the pruritus, with a slower response for reduction in vesicle formation.
- A gluten-free diet not only improves the enteropathy, but can result in reduced dapsone usage, even clearing the skin lesions.
- Other sulfonamides, such as sulfapyridine, can also produce an excellent response.
- Therapies also discussed include tetracycline combined with nicotinamide, cyclosporine, and colchicine