Dermatitis herpetiformis in Adult
The disease manifests as an intermittent pruritic, papulovesicular eruption over the extensor surfaces of the extremities, buttocks, and scalp. Many patients who adhere to a strict gluten-free diet experience complete remission of their disease.
Patients with DH are at an increased risk of developing thyroid disease, most commonly Hashimoto thyroiditis. Insulin-dependent diabetes mellitus and pernicious anemia have also been reported. Patients with gluten-sensitive enteropathy are also at increased risk of enteropathy-associated T-cell lymphoma and therefore warrant close surveillance. Gluten avoidance may decrease the risk for lymphoma. A population-based study from Finland strongly suggests an increased risk of bullous pemphigoid in patients with DH.
L13.0 – Dermatitis herpetiformis
111196000 – Dermatitis herpetiformis
Differential Diagnosis & Pitfalls
- Scabies manifests with interdigital burrows and involvement of the hands, wrists, and genital region, sparing the head.
- Papular urticaria may be associated with arthropod bites and is distributed over exposed areas.
- Bullous pemphigoid presents with urticarial erythematous plaques and intact, tense bullae in older patients.
- Linear IgA bullous dermatosis presents with grouped vesicles and bullae, classically in an annular configuration.
- Atopic dermatitis is also pruritic, with ill-defined, weeping, erythematous plaques.
- Herpes simplex virus has nonsymmetric, localized, clustered vesicles with more pain and less pruritus.
- Epidermolysis bullosa acquisita may have associated milia.
- Transient acantholytic dermatosis (Grover disease) is a pruritic papular eruption in the seborrheic regions of older men.
- Neurotic excoriations are distributed in areas within reach for the patient to scratch, and no primary lesions are appreciated on examination.
- Pemphigoid gestationis is characterized by tense bullae over the abdomen in pregnant patients.
- Chronic prurigo consists of lichenified excoriated papules or nodules.
- Prurigo pigmentosa usually affects the back, chest, and neck; the forehead and arms are rarely involved.
- Evaluate for other causes of pruritus.
Drug Reaction Data