Dermatitis herpetiformis is a chronic recurrent skin lesion, manifested by a polymorphic rash in the form of erythematous spots, blisters, papules, blisters and accompanied by severe itching and burning. The disease got its name due to the fact that the elements of the rash in During dermatitis are grouped in the same way as rashes in herpes. Diagnosis is carried out using histological examination, analysis of the contents of the bubbles and direct immunofluorescence reaction. In the treatment of dermatitis herpetiformis, the sulfone group of drugs and corticosteroids are effective.
General information
Dermatitis herpetiformis occurs at any age, but it most often develops in 30-40 years. Men are more susceptible to this disease than women. In some cases, dermatitis herpetiformis is a skin reaction to a malignant tumor of internal organs present in the body, that is, it acts as a paraoncological dermatosis.
Causes
The causes and mechanism of development of dermatitis herpetiformis are unknown. Many patients are found to be intolerant of the protein gluten contained in cereal plants. The detection of IgA antibodies at the border of the dermis and epidermis – in the area of the basement membrane — speaks in favor of the autoimmune component in the development of the disease. It is assumed that an increased iodine sensitivity, heredity, ascariasis, inflammatory processes of the gastrointestinal tract (gastritis, peptic ulcer), viral diseases (ARI, herpetic infection, etc.) play a certain role in the occurrence of dermatitis herpetiformis.
Symptoms
Usually, dermatitis herpetiformis has an acute onset with the appearance of foci of polymorphic rash. Rashes may be preceded by a moderate rise in body temperature, general weakness, itching and tingling. Rash elements can occur on any part of the skin, except the soles and palms. But their most frequent location is the extensor surfaces of the arms and legs, the area of the shoulder blades, shoulders, lower back and buttocks. Petechiae and ecchymoses may occur on the palms — large (more than 3 mm) spots of intradermal hemorrhages. Rashes are accompanied by pronounced discomfort: burning sensation, intense itching and paresthesia. The lesion of the mucous membranes in dermatitis herpetiformis, as a rule, is absent. In rare cases, bubbles may occur in the oral cavity, quickly turning into erosion.
The true polymorphism of the rash in dermatitis herpetiformis is associated with the simultaneous appearance of erythematous spots, blisters, papules and blisters on the skin of various sizes. Over time, a false polymorphism is added to the true polymorphism: erosions and crusts associated with the transformation of rashes are formed, as well as excoriations caused by strong scratching of the skin. When the elements of the rash heal, foci of hypo- and hyperpigmentation remain on the skin, sometimes scars.
Erythematous spots in dermatitis herpetiformis have a clear contour and a rounded shape. Their smooth surface is often covered with scratches, bloody and serous crusts. Over time, they are soaked with effusion from dilated vessels and turn into blistering-like (urticaria-like) formations. The latter grow along the periphery and merge, transforming into pink-cyanotic foci covered with crusts, combs and bubbles. Along with this, erythematous spots can turn into juicy pink-red papules. In addition, the appearance of papules and urticaria-like rashes can occur without the stage of an erythematous spot.
The vesicular elements of the rash in dermatitis herpetiformis can be small in size — vesicles and with a diameter of more than 2 cm — bullous rashes. They are filled with a clear liquid, the turbidity of which indicates the attachment of infection. The bubbles open and dry out to form a crust. Due to combing, the crust is removed and erosion remains in place of the bubble.
Depending on the predominance of one or another type of rash over the rest, the following types of herpetiform dermatitis of During are distinguished: papular, vesicular, bullous and urticaria-like. Atypical variants of the disease are possible: trichophytoid, eczematoid, strofuloid, etc.
Acute periods of dermatitis herpetiformis are combined with fairly long remissions (from several months to a year or more). Exacerbations often occur with deterioration of the general condition of the patient, fever, sleep disorders.
Diagnostics
If herpetiform dermatitis of During is suspected, an iodine test of Jadassone is carried out. A compress with an ointment containing 50% potassium iodide is applied to a healthy area of the skin. After 24 hours, the compress is removed. The detection of redness, vesicles or papules in its place speaks in favor of dermatitis herpetiformis. If the sample is negative, then it is repeated. To do this, after 48 hours, the same compress is applied to the area of pigmentation remaining after the former rashes. The Yadasson test can be carried out with the intake of the iodine preparation inside. But such a study is fraught with a sharp exacerbation of the disease.
With dermatitis herpetiformis, an increased content of eosinophils is detected in the clinical blood test. Cytological examination of the contents of the bubbles also reveals a large number of eosinophils. However, these data, like the Yadasson test, are not mandatory or strictly specific for the disease.
Histological examination of the affected skin areas is considered to be the most reliable way to diagnose dermatitis herpetiformis. It reveals cavities located under the epidermis, clusters of eosinophils, neutrophils and remnants of their destroyed nuclei. The direct immunofluorescence reaction (IFR) detects IgA deposits on the tips of the dermal papillae.
In the diagnosis of the bullous form of dermatitis herpetiformis, differentiation with other bullous dermatitis is necessary: bullous pemphigoid, pemphigus vulgaris and other types of pemphigus.
Since dermatitis herpetiformis is a para-oncological disease, it is desirable for elderly patients to conduct additional examinations to exclude oncological pathology of internal organs: ultrasound of the abdominal cavity and urinary system, lung X-ray, kidney CT, etc.
Treatment
Patients with dermatitis herpetiformis are indicated for treatment by a dermatologist. Prescribe a diet that excludes cereals and iodine-containing products (sea fish, seafood, salad, etc.). Drug therapy is carried out with drugs of the sulfone group: diafenylsulfone, sulfasalazine, solusulfone and others. These drugs are usually prescribed orally in cycles of 5-6 days with breaks of 1-3 days. In cases of ineffectiveness of sulfone therapy, treatment is carried out with medium doses of corticosteroids (prednisone, dexamethasone, etc.), antihistamines are used to relieve itching: loratadine, cetirizine, desloratadine.
Local treatment of dermatitis herpetiformis includes warm baths with a solution of potassium permanganate, opening of blisters and their treatment with zelenka or fucarcin, application of corticosteroid ointments or aerosols, application of 5% dermatol ointment.
