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2019, Number 4

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Dermatología Cosmética, Médica y Quirúrgica 2019; 17 (4)

Current Diagnostic and Therapeutic Approach to Dermatitis Herpetiformis

Ramos CCJ, Ocampo CJ, Gómez FM

Language: Spanish
References: 60
Page: 244-254
PDF size: 395.40 Kb.


ABSTRACT

Dermatitis herpetiformis (dh) is a polymorphic, blistering and chronic autoimmune disease, characterized by the presence of intensely pruritic papules and vesicles, which are distributed on limb extension surfaces and sacral region. It is considered the cutaneous manifestation of a gluten-sensitive enteropathy and its association with celiac disease (cd) has been widely demonstrated. It mainly affects the population with Scandinavian ethnicity, affecting to a greater extent men of the fourth and fifth decade of life. Its pathogenesis consists of a sum of genetic factors, idiosyncratic immune profile and exposure to environmental triggers, the most important being the gluten present mainly in wheat, barley and rye. In addition to the cutaneous manifestations, it is accompanied by subclinical alterations of the intestinal mucosa, which result in a wide symptomatology that includes abdominal distension, colic, pain, diarrhea and/or constipation. In addition to celiac disease, it is associated with hypothyroidism, type 1 diabetes mellitus, pernicious anemia, Addison’s disease, vitiligo and alopecia areata. The diagnosis is established by linking clinical data with findings of histopathology, serology and direct immunofluorescence (ifd); the latter considered the gold standard for dh. The current therapeutic approach is aimed to the early combination of dapsone as an inducer of remission and gluten-free diet (dlg) as maintenance therapy. Likewise, dh is a disease that requires interdisciplinary management and monitoring by dermatology and clinical nutrition.


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