Duhring disease — rare ailment. Signs, therapy, photo


What causes dermatitis herpetiformis?
How does DH appear?
Diagnosis of the disease
What kind of therapy is indicated for DH?
Traditional therapy
Is diet important in the fight against DH?
Prophylactic measures for DH
Forecasts and concerns

What causes dermatitis herpetiformis?

This disease affects any person, regardless of age or gender. The first studies of this disease were conducted in the 19th century. Dermatologist Louis Adolphus Duhring from Philadelphia was able to describe and characterize it in detail. That’s why this ailment sometimes called after his name.

However, the true cause of unpredictable skin pathology has not yet been identified. Based on the available theories, the following factors are figured out:

    1. Hereditary.
    2. A weak immune system that is unable to resist infection.
    3. Intestinal dysfunction, in particular, a violation of the absorption process, peptic ulcer, gastritis.
    4. Helminth infestation.
    5. Herpes.


Duhring disease is referred to the autoimmune group of diseases. This is a relatively rare type, its peculiarity of a sudden appearance in most cases concerns people over 40, but children and the elderly are not insured from it.

Rejection of gluten (which contains in cereals) from the body also appears as the cause of the disease. The autoimmune nature of dermatitis is confirmed by the presence of IgA antibodies detected between the epidermis and the dermis.

Inflammatory processes of internal organs, hypersensitivity to iodine can serve as a provoker of dermatitis herpetiformis.

How does DH appear?

Skin pathology creates not only physical but also aesthetic problems. Rash, the appearance of bubbles, erosion in prominent places (on the face, hands) are not reflected in the appearance in the best way. This fact causes negative emotions, which, in turn, can cause disease. In other words, psychosomatic provokes serious ailments, including dermatitis herpetiformis, which is not so easy to get rid of.

20-40-year-old men are most susceptible to this type of disease. Women too, but much less. Dermatitis herpetiformis more often affects the inhabitants of Northern Europe for some reason.

According to ICD 10, DH is classified: L13.0 Dermatitis Herpetiformis.

Symptoms are similar to other types of skin pathologies, but a more detailed description allows us to differentiate the disease:

  • Symmetric skin rashes almost immediately turn into bubbles, filled with ichor. They can burst themselves or the patient helps them by scratching. Content gets too healthy areas, spreading the sickness.
  • A rash spreads to limbs and other areas of the body.
  • Rashes acquire a ring-shaped pattern resembling a garland.
  • The appearance of red spots.
  • Edema.
  • Itching appears, and just after it, bubbles form within 2-3 hours.
  • Pain syndrome even without touching.
  • Burning and tingling.
  • Increased body temperature.
  • The occurrence of suppuration.
  • The upper part of the bubbles is dense, if it bursts, a crust is formed.
  • If the disease was caused due to problems with the digestive tract than feces become greasy gray.
  • The general condition is deteriorating, a person becomes irritable, too emotional or, on the contrary, sluggish and inhibited, he is overwhelmed with insomnia.

Skin rash looks different. Small vesicles or bullous with over 2 cm (0.78 inches) in diameter appear. The blister cap is tight. If the liquid in the cavities becomes brown, this indicates infection. Further, suppuration occurs at the site of the bladder, and ulcers may be the result. If they are tightened with crusts, it means that the healing process has begun.

If you disrupt the crusts that appear after opening the blistering bubbles, erosion and wounds are formed on the skin.

Dermatitis herpetiformis is characterized by exacerbation and subsequent remissions.

This disease is divided into the following types:

  1. Bullous.
  2. Urticaria-like.
  3. Vesicular.
  4. Papular.

Judging by the names, each of them differs in the form of pathological formations on the body.

The most characteristic places for a rash are forearms, neck, elbows, face.

In the photo, the symptoms of herpetiform dermatosis at the elbow bend:

Symptoms of herpetiform dermatosis at the elbow bend
Symptoms of herpetiform dermatosis at the elbow bend

More rarely rash appears on the buttocks, nape, knees, sacrum, and back.

Herpetiform dermatitis on the back
Herpetiform dermatitis on the back

DH is characterized by the absence of a rash on the palms, but in these places, hemorrhages are noticeable in form of burst capillaries. They are called petechiae or ecchymoses. The mucosa is rarely affected, but if it happens in the oral cavity, erosion occurs there.

Healed wounds leave marks in form of scars, hyperpigmentation appears.

Diagnosis of the disease

From the very beginning, the examination of a dermatologist is needed. He studies the patient’s skin and interrogates him to find out the causes and other details related to the pathology. However, external signs will not help to differentiate and make a final decision about the diagnosis. It is impossible to do without laboratory research:

  • Blood test — exceeding the norm indicator of the eosinophils’ number shows the presence of DH.
  • Histology of vesicle and bullous fluids — detection of neutrophils, tissues of destroyed nuclei, cavity.
  • Examination of the thyroid gland, the dysfunction of which can lead to skin disease (determination of the thyroid stimulating hormone’ level, total triiodothyronine in the blood, total thyroxine in the serum).
  • Primary immunofluorescence, which can determine the accumulation of fixed immunoglobulins A.

Sometimes, on the recommendation of a gastroenterologist, it is necessary to undergo a biopsy of the small intestine.

The procedure for determining the susceptibility to iodine is called Jadassohn test. An ointment, which contains 50% iodine, applied to the skin of the forearm. After 24 hours, the study of the experimental site is conducted. If the skin turns red and a rash develops on it, the test is considered positive and the diagnosis is not in doubt.

If such a test is carried out by taking iodine inside, the patient with DH will immediately have an exacerbation.

If a preliminary diagnosis has revealed the bullous form of DH, then differentiation with such ailments (as bullous pemphigoid, pemphigus vulgaris, etc.) is carried out.

The internal organs and systems are examined using special medical equipment:

  • Ultrasound of the peritoneum and urogenital system.
  • CT scan of the kidneys.
  • X-ray of lungs.

Based on the responses received, the doctor establishes a diagnosis or refutes it.

In the photo dermatitis Duhring, spread over large areas:

Duhring dermatitis spread over large areas
Duhring dermatitis spread over large areas

What kind of therapy is indicated for DH?

Before applying a medical course of treatment, the patient must be sent for a thorough examination of the digestive organs to rule out chronic, infectious and oncological diseases.

The main drug is Dapsone, it relieves the symptoms after the first dose according to the next scheme. 50-100 mg of medicine is taken 2 times per day (100-200 mg in total), within 5-6 days. Then a break for 2 days is made and again the same dosage is used. There can be from 3 to 5 procedures.

This potent drug has to be appointed with extreme caution. After relieving the pronounced symptoms, the dosage is reduced to 50 mg in 1 or 2 days. The drug is taken under the supervision of a doctor, because it can cause a number of undesirable effects, like anemia, allergies, nausea with vomiting, excessive load on the liver. The doctor warns the patient about Dapsone incompatibility with Aminophenazone and drugs containing barbiturates.

If the medication mentioned above is not suitable for a specific patient, the doctor can prescribe the next agents:

  • Etebenecid;
  • lipoic acid;
  • Methionine;
  • antihistamines;
  • Unithiol;
  • vitamin complexes of group B, rutoside, ascorbic acid./li>

Diucifon also belongs to effective remedies, it is taken for about 2 months. An individual scheme is developed for each patient, taking into account the 5-day break.

The sulfonic group also includes Avlosulfone, Sulfapyridine (according to a special scheme).

From severe itching Claritin, Zyrtec, Aerius can help.

A severe form of DH is not always treatable with the medicines listed above. In such cases, doctors are forced to prescribe hormonal agents, such as Triamcinolone, Prednisolone, Dexamethasone. These drugs can be in forms of ointments, tablets, injections for intramuscular administration.

Dermatol ointment (5%) is used to treat opened vesicles.

A solution of salicylic, boric acid, Carbol fuchsin, brilliant green – for unbroken blisters.

Sores and light forms of erosion are recommended to be treated with aniline dyes. In the case of secondary infection, aerosol medication can be given, which include glucocorticosteroids and antibiotics.

With the manifestation of DH on the oral mucosa, rinsing with antiseptic solutions can be prescribed.

If the ambulatory dermatitis herpetiformis treatment did not produce the expected result, the patient is hospitalized, in particular, with such indications:

  • The rash spreads widely over the body.
  • The lesion area is infected again.

For such patient, a dose of Dapsone can be raised or Sulfasalazine is prescribed.

Traditional therapy

Representatives of traditional medicine have a positive attitude to the use of folk remedies based on medicinal herbs. Although in each case, you need to consult a doctor.

Using such plants as knotweed, sea buckthorn, mountaineer, to prepare decoctions, tinctures or ointments, it is possible to significantly alleviate the condition of the patient.

No less effective for relieving the symptoms of dermatitis herpetiformis are mistletoe, calendula, tricolor violet, as well as licorice and juniper.

The infusion of Maral root and Aralia, decoction of Eleutherococcus perfectly strengthens the immune system.

Infusions are prepared on vodka or water in the traditional way. Alcohol tincture is infused for about 10 days, in the next proportions: 1 tbsp. of one plant and 500 ml of vodka. For decoctions use the next recipe: 7 tablespoons of herbs per 1 liter of boiling water should be left for 2-2.5 hours.

Atropa may be the basis for home-made medicinal ointment. It is enough to take 2 parts of boiled lard and 1 part of dried ground leaves of the plant. The mixture is sent to the oven (90 degrees) for 5-6 hours. The finished medicine is passed through a filter and sore spots are treated.

Is diet important in the fight against DH?

The answer is affirmative. Based on the fact that DH is caused by hypersensitivity to gluten, which is cereal, it is necessary to exclude them from the diet.

A defined list of products that are unacceptable for the disease:

  • Coffee substitutes.
  • Kvass, including homemade.
  • Beer and products with malt.
  • Flour products.
  • Beans, cabbage.
  • Products containing cocoa.
  • Ice cream.
  • Sausages, which include bread.
  • Cereals: barley, wheat, millet, oats.
  • Sea fish and seafood.
  • Feijoa.
  • Persimmon.

The next products are allowed to eat:

  • Fruits.
  • Homemade mayo.
  • Non-iodized salt and mineral water.
  • Natural coffee and tea.
  • Butter and vegetable oil.
  • Groats: buckwheat, rice, corn.
  • Natural honey.
  • Nuts (except walnuts).
  • Spices.
  • Greens and vegetables: potatoes, zucchini, carrots, beets, garlic, onions.
  • Sunflower seeds.
  • Olives.

Prophylactic measures for DH

Because of the disease etiology that has not been clarified until the end, primary preventive measures have not been developed. Therefore, if we talk about preventive measures, we mean preventing or minimizing relapses. After all, the chronic form, as a rule, is accompanied by periodic exacerbation, which are unpredictable and can occur at any time throughout life. The prevention lies in not provoking them, the main aspects of which include:

  1. Compliance with recommendations on dietary gluten-free nutrition (food containing iodine and certain types of cereals is strictly prohibited).
  2. Regular examination by a dermatologist (registration at the dispensary).
  3. Personal hygiene, which will significantly reduce the likelihood of infection.

Of course, a healthy lifestyle is a general preventive measure. After all, bad habits exacerbate the physical condition of the body, have a destructive effect on the immune system, which can lead to another exacerbation of dermatitis herpetiformis.

Forecasts and concerns

It is difficult to make a definite conclusion. Different people have different results. It is hard to count on a full recovery because of a disease cyclicity. Remissions can be incomplete and short. Still, some patients can recover, it depends on the resource of the body’s defenses.

Such a phenomenon as a new rash at the time of taking medication is not news. However, the doctor recommends that you continue to follow the established scheme.

A serious concern is a secondary infection.

And one more warning: if you do not go to the doctor at the first symptoms and do not start timely treatment, neglected DH can be a reason for such serious diseases:

  • Lupus.
  • Vitiligo.
  • Sarcoidosis.
  • Intestinal lymphoma.
  • Osteoporosis.

By strictly following the directions of oral and external medications, following a therapeutic diet, it is much easier and faster to achieve a substantial relief of the patient’s condition.

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