Treatment of dermatoses that occur with the formation of blisters – a complex task that requires the specialist to strictly adhere to the standards of therapy.
The amount of medical care depends on the degree of neglect of the disease, the age and general condition of the patient, the presence or absence of severe comorbidities, as well as the reactivity of the immune system.
On how to properly and effectively treat Duhring's dermatitis herpetiformis read on estet-portal.com in this article.
- Basic diagnostic criteria for dermatitis herpetiformis
- General medical treatment for blistering dermatosis
- Drug treatment of Dermatitis herpetiformis Duhring
- Local treatment of skin dermatoses of various origins
- Etiopathogenesis of Dühring's dermatitis: immune mechanism of skin lesions
- Clinical manifestations of Dühring's dermatitis: polymorphism of rashes
- Differential diagnosis of Dühring's dermatitis and prevention of exacerbations
Basic diagnostic criteria for dermatitis herpetiformis
To make a diagnosis of Dühring's dermatitis, it is necessary to determine the criteria for the disease. The main diagnostic features of dermatitis herpetiformis include:
1. characteristic clinical picture;
2. chronic course of the disease;
|
Diagnosis |
Dühring's dermatitis herpetiformis |
Pemphigus vulgaris |
Lever's bullous pemphigoid |
Erythema multiforme exudative |
3. increased content of eosinophils in the fluid of the blisters;
4. granular deposits of IgA in the papillary dermis;
5. detection of immunoglobulins in the blood to tissue transglutaminase (ELISA).
In addition, the content of fibrin and neutrophils in the skin biopsy is also determined histologically.
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To confirm the diagnosis, a Yadasson skin test is performed for sensitivity to iodine preparations, which is positive in clinical exacerbation of the disease.
Also for Dühring's dermatitis, a characteristic negative symptom of Nikolsky and the absence of acantholytic cells, which are necessarily found in true pemphigus.
General medical treatment for blistering dermatosis
For the first week, pemphigus vera is treated with prednisolone 80 to 200 mg in 24 hours, or triamcinolone or dexamethasone at the equivalent daily dosage. As soon as the symptoms of the disease become less pronounced, and the patient's condition stabilizes, the dose of hormones is gradually reduced over 7 days to maintenance therapy at 10-15 mg / day of prednisolone.
Additionally assign:
• cytostatics: methotrexate;
• potassium preparations;
• ascorbic acid in maximum dosages for age and weight;
• multivitamins.
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Immediately after corticosteroid therapy, medications are prescribed to prevent osteoporosis: anabolic steroids and calcium supplements. If necessary, correction of blood glucose, arterial pressure and hormonal levels is carried out.
Drug treatment of Dermatitis herpetiformis duehring
Dapson is prescribed for the treatment of Dühring's dermatitis. One treatment cycle consists of 5-6 days of medication and 1-3 days off. Dapsone is indicated twice a day for 0.05-0.1 grams. The therapeutic course includes 2-4 cycles described above.
To prevent recurrence of Duhring's dermatitis herpetiformis, the treatment regimen includes autohemotherapy, plasma transfusion, blood transfusion, intramuscular injection of unithiol, extracorporeal hemoperfusion.
Sulfanilamide preparations, due to the low therapeutic effect, are practically not used in the therapeutic regimen .
Local treatment of skin dermatoses of various origins
During the local treatment of dermatoses, skin care is carried out carefully following the rules of asepsis and antisepsis. For the treatment of erosive surfaces, sterile dressings and napkins are used. Puncture blisters with sterile needles from syringes.
In case of dermatoses, erosive surfaces are treated with methylene blue, sea buckthorn oil, fucorcin.
Wet areas are sprinkled with dermatol mixed in equal amounts with zinc oxide. For the treatment of dermatoses of the lips, ocular conjunctiva and nasal passages, creams with corticosteroids, antibiotics and 5% dermatol ointment are suitable.
Read also: Blisters: what is important to remember
Erosions of the oral cavity are treated with dental adhesive paste, rinsed with mouth disinfectants, lubricated with aniline dye solutions.
In the treatment of dermatoses that occur with the formation of blisters, diet therapy is indicated. Organize meals at least 4-5 times a day. The diet consists of dishes enriched with vitamins, fats, raisins, apricots, pumpkin. Exclude fried, smoked foods. Limit the use of table salt to a minimum.
With Dühring's dermatitis, the use of gluten is prohibited. Without following this rule, even after drug treatment of dermatosis, it is impossible to achieve stable therapeutic remission and cure the disease.
Etiopathogenesis of Dühring's dermatitis: immune mechanism of skin lesions
Dühring's dermatitis herpetiformis is a chronic dermatosis of autoimmune origin.
The disease is characterized by a long relapsing course and the appearance of an itchy polymorphic rash on the trunk and extremities.
Dühring's dermatitis is often found as a manifestation of celiac disease, predominantly in middle-aged men. The course of dermatitis herpetiformis is relatively favorable, but it is worth paying attention to the differential diagnosis with other bullous dermatoses, especially with acantholytic (true) pemphigus – potentially fatal disease.
Duhring's dermatitis is usually found in people suffering from malabsorption syndrome – gluten enteropathy. Also, hypersensitivity to iodine plays a key role in the appearance of dermatitis herpetiformis, which indicates the allergic nature of the disease.
However, the main mechanism for the formation of Dühring's dermatitis – autoimmune. Gluten is an antigen in the patient's body and forms immune complexes in the small intestine that attack the intestinal mucosa.
Through the damaged papillae of the mucous membrane, immune complexes enter the general circulation and penetrate into the papillary dermis.
Then, immune complexes (Ig-A) are fixed in the dermis and deposited in the form of granules.
Clinical manifestations of Dühring's dermatitis: rash polymorphism
The disease begins with the appearance of itching, tingling, pain at the site of the skin lesion, and may also be accompanied by general malaise, fever.
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Soon, symmetrical rashes appear, which are most often localized on the extensor surfaces of the limbs, the skin of the trunk and buttocks.
Among the primary elements are:
• erythematous spots and papules: when confluent, they form various contours and shapes;
• tense vesicles: tend to cluster and herpetiform placement. After opening, the vesicles form erosions, crusts and leave hyperpigmentation;• tense bubbles: the diameter of the elements is 0.5-2 cm or more with cloudy contents. When resolved, persistent hyperpigmentation is also left. The appearance of blisters on the oral mucosa Differential diagnosis of Dühring's dermatitis and prevention of exacerbations
Dühring's dermatitis must be differentiated from diseases such as pemphigus vera, Lever's bullous pemphigoid, erythema multiforme exudative, subcorneal pustular dermatosis, bullous toxicoderma, epidermolysis bullosa. xxxx>
Prevention of exacerbations of dermatitis herpetiformis includes: following a gluten-free diet, as well as avoiding drugs and products containing iodine.
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