Dermatitis herpetiformis (also known as ‘DH') is a rare but persistent blistering skin condition related to coeliac disease.
Dermatitis herpetiformis is an ‘immunobullous' condition, which means it is a blistering condition caused by an abnormal immunological reaction. Like other forms of coeliac disease, it involves IgA antibodies and intolerance to the gliaden fraction of gluten found in wheat, rye and barley.
Dermatitis herpetiformis often affects young adults; two thirds of patients are male. There is a genetic predisposition; there are associations with human leukocyte antigens (HLAs) DQ2 DQ8.
Eighty percent of patients with dermatitis herpetiformis also have gluten enteropathy, the most common form of coeliac disease. Some patients have personal or family history of other autoimmune disorders.
Dermatitis herpetiformis is unrelated to other forms of dermatitis such as atopic eczema.
Dermatitis herpetiformis is characterised by extremely itchy bumps (prurigo papules) and blisters (vesicles), which arise on normal or reddened skin. They tend to be distributed symmetrically and are most often found on the scalp, shoulders, buttocks, elbows and knees.
As the blisters are so itchy, they are often immediately scratched, resulting in erosions and crusting. Older lesions may leave pale or dark marks (hypopigmentation and hyperpigmentation). Flat red patches, thickened plaques and raised wheals may arise, resembling eczema, scabies and other skin conditions.
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