Dermatitis herpetiformis

Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis, angioedema, urticaria, various skin disorders, such as lichen planus or keloids... 

Comedo (pi. comedones) Dermatitis Dermatitis herpetiformis Plug of dried sebum in the sebaceous duct blackhead Inflammation of the skin Dermatitis marked by grouped erythematous, papular, vesicular, pustular, or bullous lesions occurring in varied combinations... 

Calcium gluconate - To decrease capillary permeability in allergic conditions, nonthrombocytopenic purpura and exudative dermatoses such as dermatitis herpetiformis for pruritus of eruptions caused by certain drugs in hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity, provided the patient is not receiving digitalis therapy. 

Dermatologic diseases Pemphigus bullous dermatitis herpetiformis severe erythema multiforme (Stevens-Johnson syndrome) mycosis fungoides severe psoriasis angioedema or urticaria exfoliative, severe seborrheic, contact, or atopic dermatitis. 

Throughout this publication, when not otherwise specified, dermatitis herpetiformis is included under the general term celiac disease. 

TABLE 6.1 Pivotal in vivo clinical studies of the effects of oats in patients with celiac disease and dermatitis herpetiformis... 

Abs, Antibodies CD, celiac disease DH, dermatitis herpetiformis Dx, Diagnosis EM, endomysial antibodies GI, gastrointestinal GFD, gluten-free diet IELs, intraepithelial lymphocytes IFN, interferon Lab, laboratory tTG, tissue transglutaminase antibodies Ret, reticulin IH, immunohistochemistry. 

Janatuinen et al. (1995) were the first to evaluate the possible toxicity of oats in a large controlled study. Since then, a number of studies (Table 6.1) have assessed the safety of oats consumption by individuals diagnosed with celiac disease and dermatitis herpetiformis. Most studies were conducted on adults, with a smaller number of studies performed on children. 

Available scientific data evaluating the introduction of pure oats in the gluten-free diet of patients with celiac disease and dermatitis herpetiformis indicates that moderate amounts of pure oats are well tolerated by the majority of these individuals who are either in remission or newly diagnosed. The term "pure oats" is used to indicate oats uncontaminated with gluten from other cereal grains, like wheat, barley, and rye, as detected by current test methods. Based on pivotal clinical trials in the published literature, the amount of pure oats considered within safe limits is 50-70 g/day for adults and 20-25 g/day for children. 

Peraaho, M., Collin, P., Kaukinen, K., Kekkonen, L., Miettinen, S., and Maki, M. (2004a). Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J. Am. Diet. Assoc. 104,1148-1150. 

Dapsone is approved for the treatment of an autoimmune blistering skin disease, dermatitis herpetiformis. This intensely pruritic eruption is characterized histologically by a dense dermal infiltration of neutrophils and subepidermal blisters. Other skin diseases in which dapsone is helpful are linear immunoglobulin A (IgA) dermatosis, subcorneal pustular dermatosis, leukocytoclastic vasculitis, and a variety of rarer eruptions in which neutrophils predominate, including some forms of cutaneous lupus erythematosus. 

Dermatitis herpetiformis PO Initially, 50 mg/day. May increase up to 300 mg/day Pneumocystis carinii pneumonia (PCP) PO 100 mg/day in combination with trimethoprim for 21 days. 

Dapsone Dermatitis herpetiformis, erythema elevatum diutinum, pemphigus, pemphigoid, bullous lupus erythematosus See also Chapter 47. 

Sulfapyridine is used to treat dermatitis herpetiformis and also has been used by veterinarians against pneumonia, shipping fever, and foot rot of cattle, This compound (2-sulfanylamidopvridine) is made by condensation of 2-aminopyridinc with the appropriate sulfonyl chloride. Its formula is shown below. 

As larger amounts of complexes are infused into experimental animals, the rate of clearance slows and vascular lesions appear, presumably as a result of overload (B9, HI, H2). Similar phenomena may occur in man, and impaired clearance has been demonstrated in several diseases associated with manifestations of immune complex deposition including systemic lupus erythematosus (F9, H8, K9, L19, P2), primary biliary cirrhosis (G19), Sjogren s syndrome (H9), and dermatitis herpetiformis (L6). Impaired clearance may be a result of circulatory overload by immune complexes, or a primary defect in mononuclear phagocytic system function may contribute or predispose to immune complex deposition (A15, A16, HI). However, impaired clearance, as currently measured, is neither a prerequisite nor a consistent consequence of immune complex disease. 

L6. Lawley, T. J., Hall, R. P., Fauci, A. S., Katz, S. I., Hamburger, M. I.,and Frank, M.M., Defective Fc-receptor functions associated with the HLA-B8/Drw3 haplotype Studies in patients with dermatitis herpetiformis and normal subjects. N. Engl. J. Med. 304, 185-192 (1981). 

Zl. Zone, J. J., LaSalle, B. A., and Provost, T. T., Induction of IgA circulating immune complexes after wheat feeding in dermatitis herpetiformis patients. ]. Invest. Dermatol. 78, 375-380 (1982). 

Wheat starch is low in protein, ash and fiber, and contains no residual sulfites. Sulfur dioxide is detrimental to the viscoelastic character of wheat gluten and is not used in the commercial production of wheat starch.28,323 The protein content of ten samples of unmodified and modified wheat starches ranged from 0.06-0.22%.28 A 0.23% protein (0.0404% nitrogen) level in wheat starch essentially indicates a gluten-free starch, as confirmed by an enzyme immunoassay.324 That purity of wheat starch is important in diets for celiac individuals. Wheat starch-based, gluten-free flour products were not harmful in the treatment of celiac sprue and dermatitis herpetiformis,325 although traces of an immunoreactive gliadin can be found in wheat starch.326... 

Seah PP, Fry L, Hoffbrand AV, Holborow EJ. Tissue antibodies in dermatitis herpetiformis and adult coeliac disease. Lancet 1971 1 834-836. 

Chorzelski TP, Sulej J, Tchorzewska H, Jablonska S, Beutner EH, Kumar V. IgA class endomysium antibodies in dermatitis herpetiformis and coeliac disease. Ann NY Acad Sci 1983 420 325-334. 

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