How dangerous is Duhring's dermatitis herpetiformis?

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.

At estet-portal.com read about clinical manifestations of Dühring's dermatitis and its differential diagnosis with other diseases.

Etiopathogenesis of Dühring's dermatitis: immune mechanism of skin lesions

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.

Immune complexes (Ig-A) are then 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.

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 is extremely rare.

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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;

Dühring's dermatitis herpetiformisPemphigus vulgarisLever's bullous pemphigoidErythema multiforme exudative3.    increased content of eosinophils in the fluid of the blisters;

Diagnosis

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.

To confirm the diagnosis, a Yadasson skin test is performed for sensitivity to iodine preparations, which is positive in clinical exacerbation of the disease.

Dühring's dermatitis also has a characteristic negative Nikolsky symptom and the absence of acantholytic cells, which are necessarily found in true pemphigus.

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.