Duhring's dermatitis. Disease herpetiform dermatitis Duhring: treatment, causes, diagnosis, prevention Dermatitis Duhring diagnosis

06.05.2020

Almost all dermatitis, as independent diseases, is characterized by a chronic relapsing course against the background of an immune failure or genetic predisposition. Was no exception and dermatitis herpetiformis Dühring (named after the 19th century physician who first described it).

Of the 10 cases, 8 are males aged 20 to 50 years. In the presence of other similar pathologies of the dermis, the risk of the disease increases dramatically (by 50% for men, by 5% for women).

Herpetic vesicular dermatitis (second name) in its manifestations resembles many others skin diseases, and always - herpes rashes that occur when infection / amplification in the body of herpes viruses type 1 or 2.

There is even a theory that a disease that is so similar to herpes may be its complication, transition viral infection subacute chronic. But it is more likely that the disease has an autoimmune nature. In favor of the latter is the fact that Dühring's dermatitis can occur against the background of autoimmune diseases of the large intestine.

According to the most obvious criterion, when examining a patient, a dermatologist divides the disease into:

acute (primary);
exacerbation;
chronic subacute;
chronic in remission.

According to the features of the main symptomatology, there are:

herpetiform (serous vesicles have a diameter of more than 1.5-2 cm);
herpetiform vesicular (bubble size up to 1 cm).

Sometimes senile herpetiform dermatitis is isolated separately, which occurs after 50-55 years of age due to age-related hormonal changes in the body without any special apparent causes.

The main feature of this disease is that, as a rule, when it occurs and develops, a specific cause of occurrence is not determined. Almost always there are several of them, many are not immediately identified.

Causes

There are three main, background reasons for the development of dermatitis herpetiformis:

Heredity - with similar pathologies in both parents, the risk of occurrence is at least 65%, if one parent is at least 30%, if both parents are healthy - the risk of getting sick is no more than 15%.
The reasons for the development of this skin disease immunological failures and some infections, which themselves are the cause or consequence of such a failure, can become.
Violation of the functioning of the gastrointestinal tract, and specifically - the processes of absorption in the large intestine (first of all, this concerns the mechanisms of absorption of gluten).

Within these 3 factors, all others operate:

autoimmune pathologies, especially those associated with the gastrointestinal tract (Crohn's disease, UC);
celiac disease - many mistakenly consider it an allergy to gluten (one of the cereal proteins), but the problem here is its poor digestion in small intestine, which causes an immune attack on the villi of the small intestine mucosa. It often happens when herpetic dermatitis is a symptomatic disease indicating problems with the absorption of gluten;
long-term endocrine disorders of any etiology (chemotherapy, drug therapy, diseases of the glands internal secretion, age-related changes);
allergic to medications and products containing a large number of iodine;
herpes viruses of various types and other viruses;
various toxic poisonings;
life under the influence of numerous negative factors: poor ecology, sharply continental climate, unfavorable social conditions, poor nutrition, constant stress, lack of sleep, smoking, alcoholism.

The features of the disease do not yet allow us to determine any unambiguous factor. Firstly, most likely, a complex of the listed conditions leads to pathology, and secondly, one or another reason will prevail in different patients.

Symptoms

Dermatitis herpetiformis in terms of symptoms is partially similar to several other skin pathologies at once:

herpes dermatitis (when the herpes virus is the unambiguous cause of damage to the dermis);
dyshidrotic eczema;
other types of dermatitis (contact, toxidermia).

Description of symptoms may vary from patient to patient. Despite the fact that the pathology is much more common in adults, there are also children's cases of this type of dermatitis.

The most complete clinical picture in the acute period is as follows:

expressed pruritus, hyperemia, swelling;
after a couple of days, transparent serous vesicles (vesicles) appear at the site of itching and redness;
serous formations burst themselves or are damaged by the patient in the process of scratching, leaving behind long-healing erosion.

This picture is observed in exacerbation in any patient, i.e. it is a mandatory set of symptoms.

The most characteristic feature of Dühring's dermatitis is serous vesicles.

Similar formations are also always observed during the attack of the herpes virus and with dyshidrotic eczema.

There is also an additional set of symptoms, the presence of which depends on the severity of the disease, the individual characteristics of the organism.

Namely:

the formation of erythema multiforme in the affected areas;
the appearance of coin-shaped eczema;
petechiae may occur - small subcutaneous hemorrhages;
the formation of blisters and papules located quite deep;
systemic symptoms can be expressed by an increase in body temperature to subfebrile values, general weakness, sleep disturbance and appetite.

Dermatitis herpetiformis, unlike other dermatitis, is characterized by symptomatic polymorphism. Those. at the same time, symptoms of different stages can be observed: itching, vesicles, erosion, erythema, temperature.

Scratching wounds and sores can lead to infections. Most often, this is St. aureus (Staphylococcus aureus) or a variety of Streptococcus.

Localization of rashes

Herpetic vesicular dermatitis in 85% of all cases affects the back - the area of the shoulder blades, as well as the shoulders and lower back.
Much less often, rashes on the skin are recorded on the reverse side - on the abdomen, neck, chest.
Rash elements in some patients were noted on the face, hips, knees, lower legs, shoulders, forearms. But never on the hands or feet.

The size of the affected areas of the skin can vary significantly:

by area - small "islands" or vast zones of tens of square centimeters;
according to the drawing - uniform points along the entire back or a complete defeat of one zone, for example, the lower back.

It is characteristic that especially many blisters of papules and vesicles are formed, as a rule, in the region of the shoulder blades.

Unpleasant signs

The pathology under consideration is not so much dangerous for physical survival (although in some cases, according to some signs, it can be dangerous), but causes discomfort in patients:

itching - everywhere and everywhere (at home, at work, on the street, on vacation, in bed);
burning, which is accompanied by the resolution of serous vesicles;
when the blisters open, the skin becomes no less repulsive - weeping, fresh sores, scabs, pigmentation;
subfebrile condition, general weakness, fatigue, sleep problems;
the section on treatment will talk about diet, and food restrictions, as you know, can greatly torment a person.

During the period of severe exacerbations, it becomes extremely difficult for the patient to lead a normal life.

Diagnostics

Diagnostics in dermatology according to the basic scheme is similar to other branches of medicine:

clinical examination, study of symptoms;
general, biochemical and special blood tests;
allergic tests to identify characteristic irritants;
microbiological examination of collected biomaterials and examination of cell morphology.

Herpetic dermatitis is diagnosed quite accurately at the stage of the initial consultation with a dermatologist. This is especially easy to do during an exacerbation, as well as against the background of associated diseases.

Diagnosis of herpetiform dermatitis is represented by the following tests:

One of the key indicators for this disease is the Yadasson iodine test.
– Potassium iodide is used as an indicator.
- First, a 50% potassium iodide ointment is left under a bandage on healthy skin for 24 hours.
- If the reactive reaction of the dermis has not occurred, then similarly, after two days, the ointment is applied to the area skin, which was previously subjected to an immune attack, but is now healed.
- If here the sample is negative, then again after two days appoint at least 2 tbsp. spoons of 3% or 5% solution of potassium iodide inside.
- A completely negative sample will be considered if there was no response to the internal reception.
- A positive Yadasson test in the presence of characteristic symptoms almost guarantees the diagnosis of Dühring's dermatitis.
General and biochemical analysis of blood.
- With this disease, eosinophilia, an increased content of leukocytes, is noted.
- Biochemistry may be normal, but sometimes there is a low albumin.
Microbiological examination of skin scrapings from the affected area.
- This operation is performed mainly in order to determine whether a secondary fungal infection has joined.
Along with the Yadasson test, histological examination bubble content.
Immunochemical analysis allows you to dismiss / confirm the herpes virus type 1 and 2.

For the elderly, diagnostic methods are supplemented by a consultation with an oncologist, ultrasound internal organs And thyroid gland, tomography. The fact is that in old age, the symptoms of dermatitis can indicate oncological processes.

Therapeutic measures

Treatment of Dühring's dermatitis is multi-stage and is determined depending on individual circumstances.

The main treatments include:

anti-inflammatory therapy;
antiallergic therapy;
diet (if skin problems come from intestinal problems, especially with celiac disease);
immune-boosting therapy.

In the treatment of patients, traditional medicine and lifestyle adjustments play a significant role.

Medicines for treatment

In a pronounced, acute condition, it is necessary to muffle inflammatory process in organism.

When the immune attack is generalized, a short systemic course of hormones is prescribed:

droppers or tablets of Prednisolone;
intramuscular injections of Dexamethasone.

Hormonal ointments are applied to the affected areas:

Akriderm, Triderm (a.i. - Betamethasone);
Lorinden A (d.v. - Flumethasone);
Hydrocortisone (a.i. - Cortisol).

If it happens differently in adults, then herpetic dermatitis in children will definitely require the use of antiallergic antihistamines:

Suprastin;
Loratadine;
Erius (Desloratadine), etc.

Preparations of the sulfonic group (Dapson, Sulfetron) actively suppress almost all classes of pathogenic microflora, preventing the development of secondary infection and sepsis. Diucifon not only blocks the development of pathogenic microflora, but also stimulates trophism, regeneration of the skin.

Finally, light and moderate pronounced forms Many patients successfully maintain Duhring's dermatitis in a state of remission thanks to such drugs, proven by Soviet medicine, such as:

Fukortsin;
brilliant green;
methylene blue;
boric acid;
zinc paste.

The mechanism of action of these substances is still not really clear, but it is undeniable that they create a therapeutic and protective film on the affected areas of the skin.

Folk methods

Traditional medicine has an extensive "arsenal" of tools that can serve as a powerful additional therapy. And during the period of remissions - a qualitative basic.

It is permissible to treat pathology with folk recipes after consultation with your doctor.

There are many options, here are just a few:

Pork fat plus dried belladonna herb (2:1 ratio).
- Melt the fat and add the grass, keep the resulting mixture in the oven at a temperature of at least 90 degrees for at least 5 hours, cool, strain - the ointment is ready.
Herbal collection.
- Calendula, nettle, juniper, yarrow, tansy, a tablespoon of each herb, pour 0.5 liters of vodka, leave for 10 days in a dry and dark place, after insisting, the resulting mixture can be used for rubbing and compresses.
A decoction of birch buds.
- 300 ml of hot water plus a tablespoon of birch buds.
- Boil over low heat for 10 minutes, strain - you can wipe the skin rashes with a swab dipped in the resulting broth.
Rubbing agent.
- 30 g of grated St. John's wort pour 200 ml of olive oil (others are possible).
- Leave in a dry, dark place for 2 weeks, strain - another rubbing agent is ready.
Weak solution of potassium permanganate.
– Suitable for compresses, short baths;
Skin baths.
- By adding herbal infusions and decoctions to the water (all water infusions) - chamomile, St. John's wort, sage, violets;
For ingestion.
- Any means with a general strengthening effect will do - tinctures of echinacea, leuzea, eleutherococcus, ginseng, aralia, calendula.

These activities should be carried out regularly, in courses, and not episodically. Otherwise, there will be little point.

Complications

The medical history of a person with Dühring's dermatosis infrequently, but regularly indicates the occurrence of negative phenomena caused by the course of the pathology.

The most famous include:

the contents of the bladder become cloudy, grayish or yellowish - a secondary infection has joined, which can greatly increase inflammation;
development of hemorrhagic syndrome;
chronic, often and severely recurrent Dühring's dermatitis, especially in the absence of adequate therapy, can provoke an autoimmune attack on other tissues, and another will begin autoimmune disease eg rheumatoid arthritis;
blisters can appear again and again, leaving very unpleasant cosmetic marks on the skin that can only be eliminated by laser surgery.

Proper Diet

The diet for Dühring's dermatitis is selected strictly individually.
Many products for the patient are quite acceptable, diet food is not a lifelong requirement.

If the patient's gastrointestinal tract is normal (which, alas, happens infrequently), then sea products and sea fish in particular are not recommended. After all, there is a lot of iodine in seafood, which is an irritant in dermatitis herpetiformis.

shrimps;
crabs;
mussels;
lobsters;
lobsters;
seaweed.

If a gastroenterologist also diagnosed celiac disease in a patient, then in most cases of this disease one has to go on a gluten-free diet for life.

Excluded:

wheat, rye flour and absolutely all products where it is contained;
cereals: barley, oatmeal, barley;
cereal substitutes for natural coffee, whiskey, beer, kvass;
most of the usual sweets, tk. all cakes, sweets, chocolates, cakes contain gluten.

After the accurate confirmation of the diagnosis and the identification of an unambiguous relationship between the deterioration of the condition and the consumption of undesirable products, a person has to re-create his menu.

fruits;
potatoes, carrots, zucchini, beets, greens;
compotes, kissels;
onions, garlic, nuts;
corn, buckwheat, rice (including flour from these crops);
vegetable, butter;
natural tea and coffee;
high-quality, all-natural cocoa and gluten-free chocolate are acceptable;
olives;
whole milk, dairy products;
chicken, beef, especially lamb and turkey;
marshmallows, marmalade without gluten additives;
yeast-free varieties of bread are acceptable, and the product must be freshly cooked.

Prevention

Dermatitis herpetiformis, like many other human pathologies, is completely incurable. Those. if it has arisen, then, like osteochondrosis or gastritis, it will always accompany a person.

It is also impossible to prevent Duhring's disease due to genetic and immune mechanisms development.

But you can make adjustments to your lifestyle so that remissions are long, and exacerbations are short and weak:

adherence to a gluten-free diet;
avoidance of any ingestion of iodine into the body: with food, medicines, during medical procedures, while breathing;
it is necessary to try to eliminate or minimize all possible foci of infection in the body;
it is necessary to observe the rules of personal hygiene, but without fanaticism;
if possible, avoid areas with poor ecology, harsh climate;
it is necessary to minimize stress;
use hypoallergenic, emollient skin creams;
be observed by a dermatologist, immunologist-allergist, if necessary, by a gastroenterologist.

Some patients have doubts: Duhring's vesicular dermatitis can be very similar to the usual exacerbation of the herpes simplex virus. And almost all of civilized humanity is infected with it.

How to distinguish herpes types 1 and 2 from Dühring's dermatitis?

Firstly, the localization of the rashes - in patients with herpes, this is almost always the nasolabial triangle, the genitals.
Secondly, there is no polymorphism in herpes.
Thirdly, an analysis for immunoglobulins with herpes will show elevated Ig G and M, and with Dühring's dermatitis - Ig A.

All patients should comply clinical guidelines doctor and do not neglect the prescribed course of treatment, even if the symptoms are mild. After all, the next aggravation may be many times stronger. And the most important thing is personal self-observation and self-education of the patient in the matter of his disease.

Conclusion

Despite the incurable, chronically relapsing nature, the described disease can be combined with a normal, comfortable life. A competently completed course of treatment during an exacerbation and subsequent prevention with a high degree of probability will turn Dühring's dermatitis only into "seasonal redness".

Dühring's disease, or bullous dermatitis herpetiformis, is a dermatosis that is characterized by a primary polymorphic rash (true polymorphism), severe itching, burning sensation, paresthesias, and a chronic course with periodic relapses and remissions.

The disease got its name in honor of the famous dermatologist from Philadelphia, Duhring.

In the late nineteenth century, he studied disease for many years.

To date, this type of dermatitis is common.

And as mentioned above, males are more susceptible to pathology than women.

External manifestations of dermatitis are unpleasant in appearance, cause a feeling of danger, the possibility of infection. Rashes on the body do not pose a threat to others.

Dühring's dermatitis is a skin disease that belongs to the autoimmune group. Its exact cause is not known, the process can begin at any age.

Most often, Duhring's disease is detected in men from 20 to 40 years old. Dermatitis is characterized by the appearance of whole groups of vesicles, blisters, which can form:

rings;
Garlands;
semirings.

Duhring's disease is characterized by a chronic, protracted course, paroxysmal appearances on the body and limbs of an itchy rash. The blisters are similar to the symptoms of herpes, which is why its other name is dermatitis herpetiformis. Clinical rashes in Duhring's disease differ in appearance:

Erythematous red spots with dilated capillaries, have a round shape, clear boundaries.
Blisters - appear when the elements are filled with liquid from the vessels. With an increase in size, individual spots merge into large foci.

Severe itching in Duhring's disease provokes combing of the areas, the appearance of crusts on top of the blisters. Herpetic dermatitis is characterized by the formation of vesicles.

These are cavities above the surface of the skin, filled with liquid, reaching sizes up to 20 mm. When dermatitis is infected, blood clots appear, the contents thicken, become cloudy, and erosive tissue is visible at autopsy.

Causes

The etiology and pathogenesis of this disease are still not clear. Experts believe that it has an autoimmune nature. In the basement membrane (on the border of the dermis, epidermis), the researchers found IgA antibodies.

A significant role in the manifestation of the disease under consideration of high sensitivity to iodine preparations was noted. During the experiment, the patient was injected with an iodide solution (3-5%). After the administration of the drug, the appearance of a rash was noted, which is typical of the type of skin disease in question.

In a large number of patients, doctors found intolerance to the gluten protein that cereals contain.

Among possible causes the following are considered:

heredity;
diseases of the gastrointestinal tract (ulcers, gastritis);
diseases with viral etiology (herpes, SARS);
ascariasis.

Numerous studies have not yet yielded results - the exact cause of the development of a chronic disease has not been established. There are several theories.

Currently, the causes of the disease are not exactly clear. Dühring's dermatitis is believed to be an autoimmune process in which the body produces antibodies against its own cells.

The disease is often associated with food allergies especially allergic to gluten. Gluten is a natural glycoprotein found in the grains of many cereals. Also, in patients with Dühring's dermatitis, sensitivity to iodine preparations and the content of this mineral in food is observed.

Dermatitis can develop against the background of work disorders digestive system or hormonal imbalances. An exacerbation can develop with hormonal disruptions and changes (puberty, pregnancy or menopause).

Sometimes nervous and physical exercise, stress, overwork and some diseases.

The exact cause of dermatitis herpetiformis has not yet been identified. It is believed that Duhring's disease is a polysystemic disease that has an autoimmune nature. Some dermatologists believe that in the development of Dühring's dermatitis great importance has a hereditary factor.

At present, the true causes leading to the development of pathology are unknown. In patients, gluten intolerance is determined, the presence of IgA antibodies in the basement membrane that separates the epidermis and dermis.

This indicates that the immune system perceives skin cells as foreign elements and begins to secrete antibodies against them.

To date, the exact causes of the development of dermatitis herpetiformis duhring have not been established. It is assumed that the disease has an autoimmune nature. It is also believed that the hereditary factor is largely “to blame”.

In support of this, dermatologists have found that the majority of those suffering from dermatitis herpetiformis have a non-inflammatory disease of the intestinal system (gastritis). In addition, an important role in the development of the disease belongs to the excessive sensitivity of the body to iodine.

Hearing the name "dermatitis herpetiformis", many people think that this rash is caused by some type of herpes virus. This is not true, because the herpes virus has nothing to do with dermatitis herpetiformis.

Dühring's dermatitis herpetiformis occurs in people with celiac disease, also called sprue, gluten intolerance, or gluten-sensitive enteropathy.

Celiac disease is an autoimmune disease characterized by intolerance to gluten (gluten). Gluten is a complex protein found in wheat, rye and barley.

It is also occasionally found in oats and other cereals that have been processed in the same facilities where other grains are processed.

89. Neurodermatosis. Etiology and pathogenesis. Classification. Clinical characteristics of limited and diffuse neurodermatitis. Differential diagnosis. Treatment.

Depending on the type of pathological elements that prevail, there are:

papular dermatitis of Duhring;
bullous;
vesicular;
urticarial.

Atypical forms of Duhring's disease:

strophuloid;
eczematoid;
trichophytoid;
paraoncological dermatosis.

Features of the clinical course in children

In most children, Dühring's dermatitis develops after an infectious disease. The onset of the disease, as a rule, is acute with a temperature rising to 39 ° during the week, and severe symptoms of general intoxication - lethargy or, conversely, agitation, lethargy and lack of appetite.

In most children, Dühring's dermatitis develops after an infectious disease. The onset of the disease is usually acute, with a temperature rising to 39° within a week. and pronounced symptoms of general intoxication - lethargy or, conversely, agitation, lethargy and lack of appetite.

Itching - feeling the need to comb.
No specific recipe for itching = speciation chuv
pain with mild irritant-itching. (epithelium
no, only epidermis) Skin and some mucus
obol (oral cavity, anus, urethra,
vagina). KZ-sim systems zab- diseases
shelter, exchange of naru, defeat of the liver, kidneys, ignition
wish. Chronic itching can - autointoxication with
zab zhkt.

Depending on the
the prevalence of itching is divided into
universal-

ny (generalized) and
limited (localized). Naib

limited locale
itching: obl nar genital
organs (vulva, scrotum) and anus. less often
zab local in the region of the inner thighs, on the lateral
neck areas.

Pitch of localized itching
often are worms (enterobiasis),

inflammatory changes
in the vulva, urethra, rectum,
og-

wounded vegetative neurosis with
local changes in microcirculation,
tro-

Other signs of skin disease

It is difficult to look at a patient diagnosed with Dühring's dermatitis herpetiformis without compassion. Signs of pathology are clearly visible.

The disease is acute and chronic stage. How does a dermatological disease develop?

Main stages:

the first sign is the appearance of a characteristic rash in the form of blisters, spots, papules;
rashes are scarlet, bright red, affect various parts of the body;
spots inside skin hemorrhages larger than 3 mm are often visible on the palms;
the body itches, there is a burning sensation;
the temperature rises to average values;
weakness is felt, the person feels “broken”, lethargic;
sleep worsens;
The patient is suffering from depression.

The disease is distinguished by the polymorphic nature of the rash. At the same time, several types of formations are present on the body - spots, blisters, vesicles, papules. This combination is rare.

After healing, areas with lighter skin and dark spots remain on the previously affected areas. Severe cases lead to scarring.

Outwardly, the considered disease is manifested only by a deterioration in the general well-being of the patient, his emotional nervousness or lethargy, as well as changes in body temperature.

Symptoms

The nature of the flow

The sometimes observed monomorphism of precipitation made it possible to distinguish a series clinical forms DG:

bullous;
herpes-like;
trichophytoid;
strophulose.

The disease is characterized by a chronic relapsing course with relapses alternating with periods of drug-induced or spontaneous complete remissions lasting from several weeks to several years. Spontaneous remissions are possible in 10-25% of patients.

GD is characterized by polymorphism, grouping and symmetry of lesions. Rashes are localized mainly on the extensor surfaces of the limbs, scalp, shoulders, knees, elbows, sacrum, buttocks, accompanied by itching.

The rash is represented by spots, blisters, papules and blisters of various sizes. Bubbles tense, with a dense cover, filled with transparent or cloudy, sometimes hemorrhagic contents, are formed on a hyperemic edematous base.

The blisters open, forming erosions that quickly epithelialize, leaving hyperpigmentation. Sometimes the skin lesion is localized.

Damage to the oral mucosa is rare. The general condition of the patients is satisfactory.

The disease begins acutely with the formation of foci of polymorphic rash. At the onset of the disease, the patient is disturbed by the following manifestations:

red spots;
blisters;
puffiness;
bubbles;
ring-shaped arrangement of bubbles.

Dühring's dermatitis manifests itself acutely, with foci of a polymorphic rash. Rashes are accompanied by fever, itching, tingling.

From other types of dermatitis, Dühring's dermatitis herpetiformis differs in the polymorphism of the rash. On the skin of a person, several pathological elements can form at once - erythematous spots, blisters, papules or blisters.

Erythematous spots differ from other elements in a smooth surface. They also have sharp edges. The patient often combs them. Later, in place of such spots, blisters or papules form. They tend to merge.

The size of the blisters can be different - from completely insignificant to 2 cm in diameter (such formations in medicine are called bullae). Inside they are filled with serous exudate, but if a secondary infection is attached, the liquid becomes cloudy.

On the skin, blisters persist for 4 days, after which they spontaneously open. Erosions remain in their place, later covered with a dense crust.

With dermatitis herpetiformis, the elements of the rash can be localized on any part of the human body. The exceptions are the soles, palms, and mucous membranes.

It is extremely rare to observe the formation of pathological blisters in the mouth. But they are very quickly reborn in erosion.

Rashes on the body are located, as a rule, symmetrically.

In addition to the appearance of a rash, other symptoms are also characteristic of Dühring's dermatitis:

a tingling or burning sensation may appear at the site of the formation of pathological elements;
insomnia;
a slight increase in temperature;
weakness;
possible allocation of loose stools;
disorders in the thyroid gland;
bubbles are arranged in groups.

Dühring's dermatitis appears as a characteristic rash of small blisters or blisters. The skin around the rash is often inflamed and red, but in some patients the rash develops on normal, unaffected skin. The rash is grouped into rings or half rings.

The blisters are covered with thick skin. At the beginning of the rash, the contents of the vesicles are transparent, but become cloudy over time. Blisters can turn into purulent neoplasms, open with the release of purulent contents and ulceration. As these sores heal, they crust over.

Dermatitis herpetiformis differs from many other dermatoses in the diversity (polymorphism) of rashes. At the same time, the skin may appear:

blisters. They usually stay on the skin for up to 4 days. Then they spontaneously open, leaving erosion in their place, which after some time become covered with crusts.
Bubbles. Their size varies from barely visible to the naked eye to up to 2 cm in diameter. As a rule, they are filled with transparent exudate, but when a secondary bacterial infection liquid may become cloudy.
papules. These formations are small seals that rise above the level of the skin. They have pronounced pink-red borders and a bizarre shape.
Erythematous spots. They usually have a smooth surface and clear contours. Such spots precede the formation of blisters and papules.

Most often, the rash appears on such parts of the body: elbows, shoulders, legs, lower back, buttocks. At the same time, there were no cases of rashes on the palms or feet. And extremely rarely this pathology manifests itself on the oral mucosa.

Typically, skin elements are grouped and arranged symmetrically on the body. They can appear both on swollen, reddened areas, and on outwardly unchanged skin. In addition to polymorphic rashes, Dühring's dermatitis has the following symptoms:

general weakness of the body;
slight tingling;
severe itching, burning;
subfebrile temperature;
drowsiness or insomnia;
copious loose stools;
deviations from the norm in the work of the thyroid gland.

Duhring's dermatitis herpetiformis begins with feeling unwell and the appearance of small formations of a polymorphic rash. The patient may have an increase in body temperature, a tingling sensation may appear.

The rash can affect any part of the body, with the exception of the palms and feet. The extensor areas of the body, the buttocks, and the lower back are most affected.

Often the rash is accompanied by itching, burning.

The rash forms in various forms: blisters, nodules, spots, papules and others.

Outwardly, the rash is very similar to herpes. It is by this criterion that the disease was called herpetiform (herpetic) dermatitis. 3-4 days the bubbles remain in the same state. Then the rash begins to spontaneously burst, forming erosion.

Duhring's disease is usually divided into the following forms:

vesicular;
papular;
bullous:
urticarial.

Spots with dermatitis herpetiformis are characterized by a rounded shape, small size with clear edges. Papules can have a variety of bizarre shapes. As a rule, rashes have a smooth surface.

Bubbles are smaller with a dense top. Inside the bubbles is a clear liquid that becomes cloudy over time. If an infection has joined the vesicles, the contents take on a purulent form.

Usually, the bubbles spontaneously open on the 4th day, forming a weeping erosion. Peripheral bubble growth is not observed. Further, the erosions are covered with crusts, which, after falling off, can form spots.

Like any skin disease, the disease in question is quite easily recognized by external signs. It usually affects the stronger sex at the age of 22-38 years. As for women, such dermatosis does not affect them very often.

Duhring's disease is one of the most itchy diseases. Common locations for the rash include:

elbows
knees
Bottom part back
hairline
back of the neck
shoulders
buttocks
hairy part heads

Diagnostics

Gomel State Medical University

The diagnosis is based on the analysis of anamnestic, clinical and laboratory data. For a diagnosis to be made, the following laboratory research:

examination of the contents of the blisters for eosinophilia;
histological examination of a skin biopsy obtained from a fresh lesion containing a cavity (bubble) reveals the subepidermal location of the cavity containing fibrin, neutrophilic and eosinophilic leukocytes;
examination of the skin biopsy by direct immunofluorescence reveals granular deposits of class A immunoglobulin in the papillary dermis;
the study of blood serum by ELISA:
- determination of the content of IgA antibodies to tissue transglutaminase in the blood;
- determination of the content of IgA antibodies to endomysium in the blood.

For rate general condition of the patient and detection of diseases associated with HD, it is possible to conduct additional studies:

biopsies of the small intestine (in rare cases, on the recommendation of a gastroenterologist);
determination of markers of malabsorption (level of iron, vitamin B12, folic acid in blood serum);
screening for other autoimmune diseases:
- determination of the content of nonspecific antibodies in the blood: antibodies to thyroperoxidase (found in approximately 20% of HD patients) and to gastric parietal cells (in 10–25% of HD patients), antinuclear antibodies;
- testing to detect thyroid diseases (testing the level of thyroid-stimulating hormone (TSH), total triiodothyronine (T3) in the blood, total thyroxine (T4) in the blood serum);
- typing for type 2 histocompatibility antigens (HLA II): DQ2, DQ

Differential Diagnosis

Differential diagnosis carried out with bullous pemphigoid, pemphigus vulgaris, linear IgA dermatosis, erythema multiforme, and also with atopic dermatitis, scabies, papular urticaria in children.

Lever's bullous pemphigoid differs from dermatitis herpetiformis in the absence of intense itching, clustering of blisters, and localization of rashes in the folds of the body. In the study of skin biopsies of patients with bullous pemphigoid, direct immunofluorescence along the basement membrane reveals class G immunoglobulins.

When the first elements of a rash appear on the skin, it is necessary to consult a dermatologist as soon as possible for diagnosis and clarification of the diagnosis. Standard diagnostic plan for Duhring's disease:

patient examination and characteristic symptoms;
conducting histological and immunofluorescent studies;
blood analysis ;
analysis of the content of pathological elements;
Thyroid ultrasound;
Yadasson's test is a test using iodine.

Herpetic vesicular dermatitis is diagnosed based on clinical symptoms and the results of a number of studies:

laboratory diagnostics blood;
study of the thyroid gland;
iodine test.

A laboratory blood test shows an increased content of eosinophils in the blood and in the contents of the vesicles. Immunological tests reveal elevated levels of immunoglobulin A.

To perform an iodine test, an ointment containing potassium iodide is applied to the forearm. Redness and rashes at the site of such a compress indicate that a person has Dühring's dermatosis. A positive reaction in this case is due to the sensitivity of many patients to iodine preparations.

In 1/3 of patients with this disease, thyroid dysfunction is detected. Therefore, it is very important to evaluate the work of this organ during the diagnosis of dermatitis.

Based on the diagnostic data, a treatment is developed. Since Duhring's dermatitis herpetiformis develops under the influence of a number of pathological processes, it is important to accurately determine the causes of the disease and treat these pathological conditions.

For these purposes, an examination of the gastrointestinal tract is carried out, endocrine system, as well as testing for oncological diseases.

Diagnosis of Duhring's disease is based on the study of the clinical manifestations of the disease. Typical signs of dermatitis herpetiformis that distinguish it from other dermatoses:

Polymorphism of rashes.
Group arrangement of bubbles.
Absence of acantholytic cells.
Cyclic flow.
High degree sensitivity to iodine preparations.
The presence of eosinophilia in the contents of the vesicles.

To confirm the diagnosis of dermatitis herpetiformis, the following studies are carried out:

Quantitative analysis of eosinophils in the contents of the vesicles and in the blood.
The Yadasson test is an iodine test. The test consists in applying potassium iodide ointment (50%) externally and ingesting potassium iodide (5% solution). If after taking there are signs of exacerbation of skin reactions, the test is considered positive.

If dermatitis herpetiformis is severe, an internal test is not carried out, since taking an iodine preparation can cause a sharp exacerbation.

It is necessary to differentiate Duhring's disease from diseases such as:

True acantholytic pemphigus.
Neacantholytic pemphigus.
Bullous toxidermia.
Multimorphic erythema.

An accurate diagnosis is made by a dermatovenereologist based on clinical picture and test results. Elderly patients are recommended to be screened for cancer. To do this, you need to do x-rays, ultrasound abdominal cavity.

The standard diagnostic plan includes the following items:

Physical examination of the patient and history taking.
Histological and immunofluorescent examination of skin biopsy.
Clinical blood test.
Examination of the contents of the bubbles.
Thyroid examination.
Test according to Yadassohn.

An iodine sensitivity test is a fairly reliable way to establish an accurate diagnosis for suspected Dühring's disease.

It was proposed by the German dermatologist Josef Jadasson. Its essence lies in the imposition of a compress on the skin with an ointment containing potassium iodide.

The patient must be bandaged for 24 hours. If after that a rash or redness appears at the site of application, then we can talk about the presence of dermatosis herpetiformis.

Diagnosis of herpetiform dermatitis consists in a thorough examination of the symptomatic manifestations of the disease. For what clinical manifestations This disease can be defined

multiple rash;
grouping of bubbles;
cyclic development of the disease;
high sensitivity to iodine and iodine-containing drugs;
a small percentage of eosinophilia in the bubble fluid.

To establish an accurate diagnosis of the disease, the following tests are carried out:

Analysis for the presence of eosinophilia in the blood and bubble fluid.
Iodine test (Yadasson test). The test is as follows: a certain amount of ointment containing iodine is applied to the skin, a 5% solution of potassium iodide is taken orally. The test is considered positive if signs of skin reactions are detected.

In severe cases of the disease, an internal iodine test is not performed, as this can cause an acute exacerbation.

It is important to distinguish Duhring's dermatitis herpetiformis from the following diseases:

pemphigus vulgaris;
erythema multiforme;
bullous pemphigoid.

It is necessary to visit a doctor if signs of illness appear. Early diagnosis Dühring's dermatitis helps to get faster healing effect to alleviate the patient's condition.

For an objective result, several laboratory procedures must be performed. Diagnostic methods for determining dermatitis include:.

general analysis blood to determine the number of eosinophils;
cytological study of the contents of the bubbles;
checking the functions of the thyroid gland;
histological examination of inflamed skin.

As a rapid diagnosis of Duhring's disease, direct immunofluorescence is used. This is a hardware study that detects the accumulation of immunoglobulins A.

One of the main tests that diagnoses Dühring's dermatosis is the Yadasson test, which fixes the body's susceptibility to iodine. The procedure is carried out as follows:

a compress with an ointment containing potassium iodide is applied to the forearm area;
after 24 hours, the result is checked - rashes, redness show a positive test.

How to identify the disease in question? What are the diagnostic protocols? Duhring's dermatitis is determined quite easily. For this, laboratory and instrumental methods are used. These include the following:

Determination of the number of eosinophils in the blood, as well as in the cystic fluid (with a disease they are significantly increased).
Study of the thyroid gland (in almost 30% of all cases, various disorders are detected).
Direct immunofluorescence revealing the accumulation of fixed immunoglobulins A.
Test with iodine. Such a diagnostic procedure is carried out as follows: an ointment containing 50% potassium iodide is applied to the forearm, which is left for a day. With a positive test, rashes and redness appear in this place.

To obtain confirmation of the presence of the disease, an examination by a dermatologist is necessary, and then a thorough laboratory examination. What needs to be identified in order to make a diagnosis of Dühring's dermatitis?

If Dühring's dermatitis herpetiformis is suspected, an iodine test of Yadasson is performed. A compress with an ointment containing 50% potassium iodide is applied to a healthy area of \u200b\u200bthe skin.

The compress is removed after 24 hours. The detection of redness, vesicles or papules in its place speaks in favor of Duhring's dermatitis herpetiformis.

If the test is negative, then it is repeated. To do this, after 48 hours, the same compress is applied to the area of pigmentation left after the former rashes.

The Yadasson test can be performed with an oral iodine preparation. But such a study is fraught with a sharp exacerbation of the disease.

With Dühring's dermatitis herpetiformis clinical analysis blood shows an increased content of eosinophils. Cytological examination of the contents of the blisters also reveals a large number of eosinophils.

However, these data, like the Yadasson test, are not mandatory or strictly specific for the disease.

The most reliable way to diagnose Duhring's dermatitis herpetiformis is histological examination of the affected skin areas. It reveals cavities located under the epidermis, accumulations of eosinophils, neutrophils and the remains of their destroyed nuclei.

The direct immunofluorescence reaction (RIF) detects IgA deposits on the tops of the dermal papillae.

In the diagnosis of the bullous form of Duhring's dermatitis herpetiformis, differentiation with other bullous dermatitis is necessary: bullous pemphigoid, pemphigus vulgaris and other types of pemphigus.

Since Dühring's dermatitis herpetiformis is a paraoncological disease, it is desirable for elderly patients to conduct additional examinations to exclude oncological pathology of internal organs: ultrasound of the abdominal cavity and genitourinary system, chest X-ray, CT scan of the kidneys, etc.

Dühring's dermatitis is best diagnosed with a skin biopsy. The doctor takes a small sample of skin and examines it under a microscope.

Sometimes a direct immunofluorescence test is done, in which the skin around the rash is stained with a dye that shows the presence of deposits of IgA antibodies. A skin biopsy can also help identify another skin disorder if the symptoms are not caused by dermatitis herpetiformis.

The diagnosis is made by a dermatologist using laboratory and instrumental methods:

Quantity determination eosinophils in the blood and cystic fluid: a significant increase.
When examining the functions of the thyroid gland, various disorders are detected in 30% of all cases.
Test with iodine: an ointment with 50% potassium iodide is applied to the forearm under a compress for 24 hours. With a positive test, redness and rashes appear at the site of application of the ointment.
Direct immunofluorescence reveals accumulation of fixed immunoglobulins A.

Treatment of Duhring's disease

Treatment of Dühring's dermatitis with folk remedies includes mainly external agents that help reduce itching and inflammation - baths with infusion of St. , oils and ointments containing extracts of the same plants.

From medicines the most effective are sulfone preparations (dapsone, diaphenylsulfone, DDS, aulosulfone, sulfapyridine, diucifon, etc.) according to a certain scheme as drug monotherapy. In cases of prolonged or severe course, they are combined with glucocorticosteroid agents.

Treatment goals:

stopping the appearance of new rashes;
erosion epithelialization;
achieving and maintaining remission;
improving the quality of life of patients.

General notes on therapy

The basis of therapy is a gluten-free diet, which leads to the resolution of the skin process, the elimination of enteropathy, the disappearance of IgA antibodies to gliadin, endomysium and tissue transglutaminase.

Dapsone is the drug of choice for the treatment of HD patients. Dapsone therapy requires careful laboratory monitoring, especially of liver and kidney function. Serious side effects, especially hemolysis, may develop. Severe hypersensitivity syndrome may also develop.

Before starting treatment, it is necessary to examine the patient for the presence of additional diseases, namely oncological diseases and pathologies of the gastrointestinal tract.

In children, treatment consists of taking gamma globulin, which is administered once every few days.

A total of 5 injections are required.

If there is a large amount of redness on the skin, and they are accompanied by itching, then it is necessary to take antibiotics.

Treatment in adults is different:

use drugs of the sulfonic series - diucifon;
taking vitamins - rutin, ascorbic acid;
antihistamines to relieve swelling and itching;
treatment of affected surfaces with antiseptic agents;
severe forms of the disease are treated with corticosteroids.

At the first symptoms, visit a dermatologist. The sooner Dühring's dermatitis is diagnosed, the easier it is to succeed, to mitigate the course of the disease.

Diagnosis of the disease includes several tests. The exact picture is established using:

iodine test of Yadasson;
biochemical analysis blood;
checking the functioning of the thyroid gland;
cytological examination contents of papules, blisters;
histological analysis of the skin from the foci of inflammation.

Important! Dermatitis with polymorphic rash is a paraoncological disease. Elderly age- a reason to additionally be examined by an oncologist, conduct a computed tomography of the kidneys, an ultrasound of the abdominal cavity, and make an x-ray of the lungs.

Therapy includes:

local funds;
diet
the appointment of drugs of the sulfonic group;
use of home remedies;
taking vitamin complexes.

The complex method of treatment includes the recommendation of a diet that provides for the restriction or exclusion (during periods of relapse) of the above foods, as well as cabbage, legumes, bean pods, bread kvass, beer, salt, seafood, sausages, chocolate, ice cream.

Dishes with rice, buckwheat, corn are recommended, the use of an increased amount of fruit, from drinks - black and green tea, natural coffee, mineral water with a low content of iodine and bromine.

Treatment of Dühring's dermatitis with folk remedies includes mainly external agents that help reduce itching and inflammation - baths with infusion of St.

Of the drugs, the most effective are drugs of the sulfone series (dapsone, diaphenylsulfone, DDS, aulosulfone, sulfapyridine, diucifon, etc.

) according to a certain scheme as drug monotherapy. In cases of prolonged or severe course, they are combined with glucocorticosteroid agents.

Therapy is aimed at eliminating the causes of the disease, which can be systemic diseases of various organs. Symptomatic treatment of manifestations of dermatitis is also used.

For these purposes, folk remedies are used. Folk remedies have an anti-inflammatory and soothing effect on the skin and prevent the development of concomitant bacterial infection.

These drugs do not cause negative side effects.

Folk remedies

It is believed that it is impossible to completely get rid of this problem. Therefore, the treatment of Dühring's dermatosis, first of all, is aimed at achieving a stable remission.

Treatment of symptoms involves taking immunomodulatory drugs from the pharmacy spectrum. As a rule, they should be taken within two months after the first appearance of inflammation.

In addition, the treatment of Dühring's dermatosis also implies oral, intramuscular or external use. hormonal drugs, which relieve inflammation, start skin regeneration processes and generally improve the condition of a sick person.

Dermatous scabs formed as a result of opening fluid blisters should be treated with anti-inflammatory ointments or sprays, which can also be purchased at a pharmacy.

Most often, Fukortsin is used for these purposes, a solution boric acid, as well as the usual brilliant green.

Traditional treatment dermatitis of this type involves the use of antihistamines, which reduce the nervous excitement of the patient. They neutralize itching and burning.

Regular intake of these drugs normalizes sleep and gives a person peace of mind. classic drug treatment dermatitis can be supplemented with the use of folk remedies that will help alleviate the symptoms of the problem.

Some doctors, instead of the usual antihistamines, prescribe to their patients drugs that have phytocompositions.

The formulas of such products are enriched with herbs and plants that have an anti-inflammatory effect on the human body and trigger regeneration processes in skin cells.

As mentioned above, this type of dermatitis is a chronic disease, and it is impossible to completely get rid of it.

A proper and carefully balanced diet will help slow down the development of new spots of dermatitis and go into a stage of long-term remission.

As a rule, with a mild course of Dühring's dermatitis, diamino-diphenylsulfone drugs are prescribed - Dapsone, Avlosulfone, etc. If these drugs are intolerant, it is recommended to prescribe drugs containing sulfapyridine.

In severe cases of Dühring's dermatitis or if the therapy described above does not work, the appointment of corticosteroids for oral administration is indicated. To relieve itching, it is necessary to select antihistamines.

External treatment of dermatitis herpetiformis consists in the use of aniline dyes, ointments containing corticosteroids. Vitamin therapy is indicated as a general tonic, vitamin B12 is especially useful.

It is important for patients with dermatitis herpetiformis to follow a diet, with the exception of foods containing gluten (oats, millet, barley, wheat and flour from these cereals) and iodine (sea fish, seaweed, seafood).

With Dühring's dermatitis herpetiformis, treatment is carried out on the background of a gluten-free diet. Gluten is mainly found in cereals (wheat, rye, oats, barley), therefore, a ban is imposed on such products:

bakery and confectionery products based on wheat, oatmeal, rye or barley flour;
pasta, semolina, pearl barley, barley groats;
meat, poultry, fish in flour breading or dough (dumplings, pasties);
first courses based on legumes;
soups with flour dressing;
cabbage in any form;
bread kvass, beer, coffee drinks;
desserts (ice cream, cream, chocolate with fillings).

Rational pharmacotherapy is used:

If the course of the disease is mild, then drugs of the sulfonic group are prescribed (Dapson, Diucifon, Sulfapyridine).
In severe manifestations of the disease, glucocorticosteroids (Methylprednisolone, Prednisolone, Dexamethasone) are recommended.
To eliminate severe itching and irritation, antihistamines are prescribed (Erius, Citrine, Claritin).
For general strengthening purposes, a complex of multivitamins (Vitrum, Supradin, Neurovitan) is prescribed.

Medicines should be prescribed by a specialist. He also adjusts the dosage and duration of the course of treatment.

This may be due to clinical efficacy and individual tolerability of a drug in each case.

In addition to oral dosage forms local funds are actively used. Skin rashes are treated with methylene blue or fucorcin and hormonal ointments are applied or aerosols are used.

To remove the inflammatory process and exclude the attachment of a secondary infection, warm baths are made with a solution of potassium permanganate. This remedy also relieves itching well.

In treatment various diseases widely used recipes traditional medicine and Duhring's disease was no exception. At home, the following remedies help to deal with the symptoms of this disease:

St. John's wort oil. To prepare it, you need 200 ml vegetable oil and 30 g of crushed vegetable raw materials (leaves and flowers). The components are combined and infused in a dark place for 10-14 days. Before use, the composition must be filtered. The agent is applied to the affected areas of the skin.
St. John's wort ointment. This recipe is more difficult to prepare. You will need juice from a freshly harvested plant and butter. Vegetable juice squeezed from raw materials is boiled in a water bath until it thickens. Then it is allowed to cool and 1 part juice and 4 parts oil are combined. The ointment is stirred until smooth. The finished product has a disinfectant, antimicrobial, wound healing and softening effect.
A decoction of birch buds. For cooking, you need 1 cup of birch buds and 300 ml of water. Boil the product over low heat for 15 - 20 minutes. After cooling and filtering. Wipe the affected areas with the finished product. This decoction has anti-inflammatory, soothing, itching properties.
Melissa tea. If fresh or dried grass is brewed three times a day instead of tea, then you can count on an anti-inflammatory and restorative effect. It is believed that with this tool you can extend the period of remission.

Therapy for Dühring's disease mild form is to accept:

Diamino-diphenylsulfone drugs (Dapson).
Preparations containing sulfapyridine (prescribed for intolerance to the above drugs).

Treatment of a severe course of the disease consists in taking the following drugs:

oral corticosteroids;
taking antihistamine drugs (to relieve itching).

For a general strengthening of the immune system, vitamin therapy is prescribed, in particular, the intake of vitamin B12.

Food	Allowed	Forbidden
Bread and bakery products	Pastries and bread made from corn, rice flour, as well as starch.	Bakery products from wheat, barley, rye flour.
Meat, fish, dairy products	Meat, fish, poultry, milk and dairy products, except yogurt.	Sausages, products with bread and meat (dumplings, pasties, and so on).
Vegetables	All vegetables, except cereals, leguminous plants, cabbage.	Peas, beans, cabbage, cereals.
Cereal dishes	Dishes from rice, corn, buckwheat.	Dishes from semolina, pearl barley, pasta, noodles.
Soups	Vegetable soups, broths, soup-puree.	Soups from peas, lentils, beans.
Fruits	Any	Without exception
Beverages	Non-carbonated mineral water, tea, coffee.	Kvass, beer, coffee drinks containing oats, barley.

Traditional medicine methods

Good results in the treatment of dermatitis herpetiformis Duhring shows the use of herbal remedies that have anti-inflammatory and antihistamine effects.

After diagnosis, patients with Dühring's dermatitis are examined for the presence of malignant neoplasms, pathologies of the gastrointestinal tract. Since the disease is characterized by a chronic course, dermatologists face the following tasks:

transfer dermatitis to the stage of long-term remission;
relieve the patient of external manifestations so that he feels comfortable physically and psychologically;
eliminate rashes so as not to provoke an infection;
show and tell methods of prevention of Dühring's dermatosis.

To obtain the best effect of the treatment of dermatitis, the patient is required to follow simple rules:

do not take baths;
exclude visiting the bath;
wash in the shower without using soap and washcloths for the affected areas;
sleep duration should be at least 8 hours;
take long walks;
avoid stressful situations;
not to be physically overloaded;
follow a diet;
take vitamins, ascorbic acid.

Before starting therapy, patients with Dühring's dermatitis are carefully examined for gastrointestinal diseases and malignant neoplasms. They are also prescribed the drug "Dapson". Its dosage is 100 mg twice a day for 5 days with a 2-day break (3-5 cycles).

After the disappearance of the signs of the disease, this medication is prescribed in a maintenance dose, that is, 5 mg every other day or 2 times a week. Side effects of the drug in question include nausea, vomiting, anemia, psychosis, liver damage and allergic reactions.

It should also be noted that the drug "Dapson" is incompatible with barbiturates and "Amidopyrine".

In addition to the mentioned drug, for the treatment of dermatosis, drugs such as lipoic acid, sodium dimeracoptopropanesulfonate, antihistamines, etebenecid, methionine, vitamins (rutoside, ascorbic acid, B vitamins).

As already noted, in order to choose the right methods of treatment, you need to do a lot of research. Firstly, it is necessary to exclude the presence of oncology, and secondly, any disorders of the gastrointestinal tract in the patient.

For the period of the disease, cereals (barley, rye, wheat, millet, etc.) and sea fish (for example, herring) should be excluded from the patient's diet, since it contains iodine.

Do not neglect this point of treatment.

Of the drugs, the sick are prescribed “Dapson” (100 mg / 2 times a day for 5 days). After a break of 2 days, the cycle must be repeated two more times.

The drug should be used even after the rashes begin to disappear. In addition to this medication, doctors may also prescribe methionine, sodium dimeracoptopropane sulfonate, lipoic acid, vitamins C and B, etebenecid, and antihistamines to relieve itching.

And for complete treatment you can give the patient other vitamins and tonics.

Patients with Dühring's dermatitis herpetiformis are treated by a dermatologist. A diet is prescribed that excludes cereals and iodine-containing foods (sea fish, seafood, lettuce, etc.).

). Drug therapy is carried out with drugs of the sulfonic group: diaphenylsulfone, sulfasalazine, solusulfone and others.

These drugs are usually administered orally in cycles of 5-6 days, with breaks of 1-3 days. In cases of ineffectiveness of sulfonic therapy, treatment is carried out with medium doses of corticosteroids (prednisolone, dexamethasone, etc.).

) To relieve itching, antihistamines are used: loratadine, cetirizine, desloratadine.

Local treatment dermatitis herpetiformis Duhring includes warm baths with a solution of potassium permanganate, opening the blisters and treating them with brilliant green or fucarcin, applying corticosteroid ointments or aerosols, using 5% dermatol ointment.

Dermatitis herpetiformis can be treated with an antibiotic called Dapsone, which is a powerful drug with serious side effects. The dose must be increased gradually over several months before it starts to have a real effect.

Most people get relief from taking Dapsone, but be aware of side effects such as:

liver problems
sensitivity to sunlight
anemia
muscle weakness
peripheral neuropathy

Dapsone may also interact negatively with other medicines such as potassium aminobenzoate, clofazimine, or trimethoprim.

Other drugs such as tetracycline, sulfapyridine, and some immunosuppressants may also be used to treat dermatitis herpetiformis. However, these drugs are less effective than Dapsone.

While this diet is difficult for many people with celiac disease to follow, it has the most beneficial effect on your health. Any reduction in gluten intake can help reduce the amount of medication you need.

Before starting treatment, patients with Dühring's dermatitis should be examined to identify diseases of the gastrointestinal tract and malignant neoplasms.
A diet is shown with the exception of wheat, oats, millet, barley and other cereals, as well as products containing iodine (sea fish).
Dapsone - 100 mg 2 times a day for 5 days with 1-2-day breaks (3-5 cycles or more). After the disappearance of the manifestations of the disease, it is prescribed in a maintenance dose (5 mg every other day or 1-2 times a week). Side effects dapsone: nausea, vomiting, anemia, liver damage, psychosis, allergic reactions; dapsone is incompatible with amidopyrine and barbiturates.
In addition to dapsone, sodium dimeracoptopropanesulfonate, methionine, lipoic acid, etebenecid, vitamins (ascorbic acid, rutoside, B vitamins), and antihistamines are also used.

Course and forecast

The course of Dühring's dermatitis is cyclic, long-term, with incomplete short-term remissions; however at a part of patients complete independent remissions are noted. Against the background of ongoing therapy, new rashes may appear, which is not considered an indication for a change. daily dose drug.

In most patients, strict adherence to the diet produces significant improvement but does not reduce the need for dapsone.

After the diagnosis is made, drugs of the sulfonic series (Dapson, Diaphenylsulfone, Autosulfone) are prescribed and multivitamin complexes. Diseases must be ruled out before starting therapy. digestive tract and the presence of neoplasms.

Systemic antihistamines (Suprastin, Claritin) are used to relieve itching; if they are ineffective, corticosteroids (prednisolone, dexamethasone) are used. In severe cases, autohemotherapy is prescribed - intramuscular injection a small amount of blood taken from a vein.

Locally prescribed:

Fukortsin.
aniline dyes.
Dermatol ointment.
Brilliant green solution.
Anti-inflammatory sprays.
Corticosteroid ointments.

The diet for Dühring's dermatosis excludes foods containing wheat, barley, rye and other cereals. You should also avoid direct contact with iodine and food in which it is found in large quantities (fish and seafood). Recommended consumption of vegetables, chicken, nuts, eggs, green salads, fruits and lactic acid products.

Medications

The therapy is carried out under the guidance of a dermatologist. Mandatory activities:

taking drugs of the sulfonic group: Dapsone, Diaphenylsulfone, Diucifon, Autosulfone. The course is 5–6 days, a break of 1–3 days, then the treatment is repeated until the signs of dermatitis disappear;
sometimes sulfone therapy is ineffective. The doctor prescribes corticosteroids - Dexamethasone, Prednisolone. Moderate doses of potent drugs are recommended;
antihistamines relieve signs of allergies, reduce itching. Suprastin, Erius, Zirtek, Claritin are effective;
intake of vitamins of various groups. good effect give multicomponent vitamin complexes.

To alleviate the patient's condition, get rid of rashes will help local remedies.

The skin is treated

Fucorcin;
aniline dyes;
Dermatol ointment;
brilliant green solution;
anti-inflammatory sprays;
corticosteroid ointments.

Are folk recipes effective?

Dermatitis located on initial stage development, you can try to cure folk remedies.

Many recipes are effective and really help patients:

tea with melissa. The symptoms of the disease will gradually recede, and most importantly, the remission period will be much longer. To do this, you need to drink tea with lemon balm daily. The tool has a good anti-inflammatory property;
decoction of birch buds. It is often used for any skin diseases. It is able to soothe, relieve itching and irritation. To prepare it, you need 300 ml of water and a glass of kidneys. All this is boiled over low heat for 20 minutes. Chilled broth wipe the skin;
St. John's wort ointment. The medicinal herb has antimicrobial and disinfectant properties. Affected areas will recover faster. The plant is harvested in summer. Then they are crushed, squeezed out the juice, and boiled in a water bath. On low heat, the juice will evaporate. The finished product is combined with butter 1:4.

A good remedy is a decoction of violets. Reception of such means as sea buckthorn, calendula, give a positive effect.

Herbs are good anti-inflammatory agents. Decoctions can be used not only externally. Many take them internally.

Despite this positive picture, it is important to remember that medicinal herbs can not replace full-fledged drug therapy.

Prevention

Primary prevention of dermatitis herpetiformis has not been developed. A measure of secondary prevention is the observance of a gluten-free diet by patients with dermatitis herpetiformis and gluten enteropathy (celiac disease).

Dühring's dermatitis is classified as a chronic disease. Relapses can occur throughout the life of the patient.

To avoid relapses, complications, follow the recommendations of a dermatologist. TO preventive measures include:

Diet tracking. It is necessary to exclude from it iodine-containing products (seafood, walnuts, medicines containing iodine), cereals (rye, oats, wheat, barley).
Be on dispensary observation, regularly undergo examinations.

It is important to carry out not only the treatment of the disease, but also its prevention.

Which is based on the following points:

patients with Dühring's dermatitis are examined for the presence of malignant and benign formations;
stick to a strict diet. Exclude from your diet foods such as oats, wheat, millet;
during the treatment period, take one hundred milligrams of Dapsone for 5 days. After the symptoms begin to gradually recede, the intake should be reduced to two times a week;
observe hygiene;

Prevention includes taking medications, so you need to discuss it with your doctor in advance.

It is almost impossible to prevent the development of Dühring's dermatitis. Sometimes the disease manifests itself in childhood. Such patients often recover over time without specific treatment.

If you suspect herpetic vesicular dermatitis, stop taking products containing cereals. A gluten-free diet is expensive, and groceries are hard to come by. Many patients order special mixtures and products abroad.

Violation of the principles of nutrition turns into serious consequences, rashes are difficult to treat. Do everything in your power to avoid complications.

Have you been diagnosed with Dühring's dermatitis herpetiformis? Follow a gluten-free diet, do not eat foods containing iodine, strengthen the body. Do not despair! There are worse diseases!

primary prevention Duehring's disease does not exist, and to prevent recurrence, it is important for patients to strictly adhere to a gluten-free diet.

Duhring's disease proceeds for a long time, periods of exacerbation alternate with remissions. With treatment and the exclusion of gluten-containing products, it is possible to reduce the frequency of relapses to a minimum.

Duhring's disease is a chronic, relapsing disease, although there are cases of complete remission. For preventive purposes, it is important to pay attention to such points:

Constantly adhere to a diet that excludes cereals from the diet, as well as foods rich in iodine (seaweed, sea fish).
Avoid medications and diagnostic measures using iodine.
Pay due attention to hygiene, as well as clean and moisturize the skin in a timely manner.
Restore body strength during healthy sleep.
Arrange regular walks in the fresh air (2 - 3 hours a day).
Avoid emotional overload, overheating, hypothermia or injury.
Prophylactic small doses of DDS.

Duhring's dermatitis herpetiformis often has recurring severe relapses. It is quite difficult to make an accurate prediction for any of the forms of this disease.

Sometimes recurring rashes of large blisters lead to disability, and in older people there may even be a fatal outcome. But a timely visit to a doctor and strict adherence to all his recommendations can significantly improve the quality of life of those who are faced with this disease.

Unfortunately, it will not be possible to completely get rid of Duhring's disease, but it is possible to forget about it on long time. For this, attention should be paid to the prevention of dermatitis herpetiformis. To exclude cases of relapse, you should follow the instructions of a dermatologist:

strictly follow a diet;
exclude drugs containing iodine;
be in dispensary.

Preventive measures for Dühring's disease - dermatitis - include:

exclusion of diagnostic studies using substances containing iodine;
hygiene;
avoidance of hypothermia, overheating;
reduction in fat intake;
exclusion of stress;
elimination of foci of infection in the body;
taking Dapsone as directed by your doctor.

Forecast

The disease is cyclical. For most patients, there is a favorable prognosis. But for this you need to follow the recommendations of a specialist, follow a diet.

Treatment of the disease is long, begins only after complete examination patient. The course of treatment takes a lot of time and, as a rule, has a cyclical nature.

Drugs used in treatment include:

methionine;
diapson;
vitamins;
flucinar;

Since this disease is chronic, it is impossible to completely get rid of it.

But timely therapy and prevention allows you to forget about it for a long time. Therefore, even an experienced doctor, speaking about the prognosis, will not say that the disease has been cured and will not bother you anymore. Unfortunately, it is not.

Diet for dermatitis

So, what can not be eaten with Dühring's dermatitis? A feature of therapy is a mandatory diet, in which the following are prohibited:

cereals and legumes,
food with flour and malt,
kvass, beer and coffee substitutes,
chocolates and ice cream
flour products and breaded products,
sausages,
iodine-containing products.

Note! Cabbage with Dühring's dermatitis is also prohibited for use.

A gluten-free diet is recommended for patients diagnosed with vesicular dermatitis herpetiformis. The exclusion of the protein of cereals (wheat, barley, rye, oats, soybeans) will prevent pronounced allergic reactions.

For baking, use special gluten-free flour, thermophilic yeast. Lean on:

vegetables;
chicken;
seeds;
eggs;
nuts;
green salads;
fruits;
lactic acid products.

Remember! Sausage, convenience foods also contain soy or wheat protein. Replace these foods with lean red meats.

An important point is the ban on the use of iodine-containing seafood. Exclude from the menu:

shrimps;
sea fish, caviar;
mussels;
lobsters;
seaweed;
lobsters.

Most people are aware of the obvious benefits of valuable seafood due to high content iodine. For patients with dermatitis with polymorphic rashes, the use of seafood turns into characteristic signs of allergy.

Diet plays an important role in the treatment of Duhring's disease. It is worth emphasizing that cereal protein can provoke the development of pathology or deterioration of the patient's condition, so it is strictly forbidden to take it. Also, the diet provides for the exclusion from the diet of such products:

mussels;
sea fish;
caviar;
crabs;
shrimps;
seaweed;
lobsters.

Diets must be followed by both children and adults. Food is recommended to be taken often, but in small portions. While dieting, it is important to drink enough fluids ( mineral water, tea, juices, etc.).

The main task of the organization proper nutrition with Duhring's disease - the exclusion of food containing iodine, gluten. It is required to give up cereals - barley, wheat, rye, all dishes and products in which they are contained. With dermatitis, you need to remove from the diet:

flour products;
coffee substitutes;
pasta;
kvass;
chocolate;
beer;
sausage containing bread ingredients;
dishes with breading;
ice cream;
sea fish;
mussels;
shrimps;
caviar;
lobsters;
seaweed.

How else is Dühring's dermatitis treated? A diet for such a disease is required. Sick people are shown a diet with the exception of oats, wheat, millet and barley, as well as other cereals.

In addition, patients with Dühring's dermatitis are prohibited from eating foods containing iodine (for example, sea fish).

Dermatitis herpetiformis Duhring is most often diagnosed in adults, starting at the age of 30. Cases have been registered when the disease occurs against the background of oncology (internal organs), i.e. paraoncological dermatitis. The disease in children develops very rarely, but still such cases take place.

This disease has been known since the 19th century, thanks to the professor who discovered and described it, his name became the basis for the name of the disease - Dühring's dermatitis.

This disease is considered chronic, but despite this, subject to the necessary preventive measures relapse can be avoided.

Dermatitis herpetiformis Duhring 8 photos with a description

Causes of dermatitis herpetiformis Duhring

The exact causes provoking the development of the disease have not been fully established, but a number of factors have been identified that, according to experts, can become a catalyst for the development of this type of dermatitis, these include internal factors:

autoimmune diseases;
malfunctions of the endocrine system;
hormonal surges - pregnancy, menopause;
allergies to protein/gluten/drugs/vaccines;
diseases of the gastrointestinal tract;
low level of immunity;
oncology;
severe overwork / stress / mental illness;
viral invasions;
hereditary factor.

In addition to allergies to proteins or gluten, hypersensitivity in such patients to iodine.

Symptoms of Duhring's dermatitis herpetiformis

The disease is characterized by slow development, the symptoms at the initial stage are so insignificant that they may not be noticed by the patient, because of this, dermatitis takes a chronic form. From a week to months, itching and burning of the skin is observed. A person may not pay attention to this, although in this case these symptoms are considered harbingers.

On the skin, which was previously itchy, a rash appears, which includes papules, vesicles, nodules, spots (a mixture of various rashes is called a polymorphic rash), then crusts and erosion may be added (secondary polymorphism). The rash is accompanied by severe itching and discomfort in places of localization.

The spots on which the rash is located have clear boundaries, often they are small round in shape. The spots are distinguished from the rest of the skin by a pink tint, and may rise and be palpable when touched.

As the disease progresses, the rash becomes similar to the course of urticaria. The so-called urticaria or nodular rash is formed.

A nodular rash tends to merge into single segments, forming large areas of affected skin, vesicles are noted on the surface, which are covered with crusts due to constant scratching. Mergers can reach up to 30 cm in diameter, and take on different shapes.

The vesicles themselves can be found not only on spots, but also on healthy skin, inside this rash there is a cloudy liquid, and the size of papules / vesicles does not exceed 3 mm.

With constant scratching, there is a danger of infection, then the cloudy liquid becomes darker in color (pus forms). The opened vesicles form eroded areas, the skin in these places becomes red, the erosions do not merge with each other.

The rashes are usually localized symmetrically, most often the rashes are prone to rashes - the head, face and neck, less often the limbs (places of bends of the arms and legs), and the rash can also be located on the body and lower back.

There are forms, the most common:

Papular - papules with a clear red top.
Bullous - vesicles are larger than in other currents.
Urticarial - the rash resembles nettle burns.

In addition to the characteristics of the rash, there are forms depending on the course and symptoms:

Acute - symptoms appear abruptly, there is a deterioration in the general physical condition.
Chronic - long periods of remission can be observed, periods of remission are replaced by periods of exacerbation.

It is possible to distinguish the general characteristic signs of herpetiform dermatitis:

unbearable itching causing sleep disorders;
burning and pain in the localization of the rash;
deterioration in physical condition.

You can see what dermatitis herpetiformis looks like in children and adults in the photo section.

Treatment of dermatitis herpetiformis Duhring

Before starting treatment, it is necessary to carry out a number of diagnostic measures to make an accurate diagnosis, since Dühring's dermatitis has similar symptoms with diseases such as urticaria, herpes rash, etc.

For diagnostic purposes, appoint:

Yadasson's test - a compress is applied to a healthy segment of the skin with iodine for a day, in case of a rash under the compress, the diagnosis is confirmed.
A complete blood count - an elevated level of eosinophils will indicate the presence of this dermatitis.
Scraping of skin particles from the affected areas for further histological examination is recognized as the most informative diagnostic method.

Abdominal ultrasound may also be ordered. genitourinary system and kidneys; X-rays of light.

Based on the obtained tests and diagnostic studies, the doctor prescribes therapy.

Treatment of dermatitis herpetiformis involves complex therapy and always under the supervision of the attending physician (often a dermatologist). The treatment of this type of dermatitis takes a long period of time, and involves the constant delivery of tests for control.

The following medications are prescribed:

tablets of the sulfonic group - they are taken in a cycle, such treatment is considered the most effective;
corticosteroids - in cases where drugs based on sulfone preparations have not given a positive result;
antihistamine tablets and ointments - to relieve discomfort;
solutions and ointments - for local treatment;
vitamin complexes - to maintain or increase the level of immunity.

Self-medication is unacceptable for Dühring's dermatitis, especially for children. Incorrectly selected drugs can lead to a chronic form and other negative consequences, the doctor prescribes therapy based on the tests obtained and taking into account the characteristics of the body.

beans;
cereals;
kvass / beer;
sweets - especially chocolate and coffee;
products containing iodine.

Treatment of Dühring's dermatitis herpetiformis with folk remedies

Traditional medicine has many recipes for effective fight with dermatitis herpetiformis. It is important to remember that alternative medicine can only be used as an adjunct to the main treatment.

The most popular recipes for the treatment of Dühring's dermatitis:

decoctions of herbs - the most popular herbs for making a decoction of calendula / chamomile / licorice. These herbs have an anti-inflammatory effect, help relieve swelling and redness of tissues;
herbal infusions - tansy / juniper / nettle is used to prepare the tincture, it is prepared to wipe the affected areas. These herbs have a calming and regenerating effect.

In addition to decoctions and herbs, alternative medicine includes a difference in recipes for preparing homemade ointments, but experts recommend treating wound surfaces with pharmaceutical ointments, because. finding real animal fat is not easy enough and it is quite expensive, the shelf life of such ointments is short, and there is also the possibility of infection.

Pharmacy ointments are sterile and have a longer shelf life.

By using folk recipes, you can alleviate the condition a little, but herbal medicine is not able to have a detrimental effect on infections, so taking medications is necessary.

Before using any traditional medicine recipes, you must first consult with your doctor about the possibility of using any drugs. This is especially important in relation to children.

Prevention of dermatitis herpetiformis Duhring

Since Dühring's dermatitis is recognized as a chronic disease, the main task is to minimize relapses that occur from time to time. In order to prevent it is necessary:

Follow the diet recommended by your doctor.
Complete examinations according to the schedule agreed with your doctor.
Complete the course of treatment, even if the symptoms subside.
Observe the rules of personal hygiene.
Get tested for other diseases.
Treat acute and chronic diseases of internal organs.
Avoid allergens.

It is important to remember that this article is for informational purposes only and is by no means a guide to action. If you have any symptoms similar to the manifestation of herpetiform dermatitis, you should immediately visit a doctor.

Dermatitis herpetiformis(or Duhring's dermatitis herpetiformis, painful polymorphic dermatitis of Broccus) is a specific dermatological pathology that occurs in people with celiac disease. For this reason, this type of skin disease is also called celiac disease.

In addition to this, even the name "herpetiformis" can be misleading to many: in fact, at first glance, one might think that this form of dermatitis represents a certain connection with infections caused by herpes simplex. In fact, the etiopathological correlation with herpes no: the term herpetiformis has in fact been attributed to certain manifestations of this dermatitis with the appearance of certain body formations, blisters and crusts that resemble the typical signs left by the aforementioned virus.

The name "Dühring" belongs to the doctor who first identified and described in 1884 this disease. Later, in 1988, this disease was also clinically described by Brokk (hence the name "Brock's painful polymorphic dermatitis"). However, it took scientists more than 70 years to identify a close link between this disease and celiac disease, it was established in 1966.

Epidemiology

Fortunately, Dühring's dermatitis is one of the rare diseases, with an incidence of 1 in 10,000 people.

Dermatitis herpetiformis occurs in young people and adults, and very rarely the disease affects children and the elderly. It is especially common in people with gluten intolerance in northern Europe.

Although rare in infants, DH can show its first symptoms during adolescence, with a higher incidence among women. On the contrary, in adulthood men suffer the most.

Statistics also link dermatitis herpetiformis to celiac disease, with skin disease occurring in one in five subjects with celiac disease.

Causes

Dühring's dermatitis is classified as autoimmune bullous dermatosis, despite the fact that inclusion in this category is questioned by experts: as we have already found out, in fact, dermatitis herpetiformis is closely related to celiac disease. In this regard, dermatitis can be considered a skin manifestation of celiac disease or gluten intolerance: it is gluten that is the cause of the abnormal antibody response (immunoglobulin type A) responsible for skin manifestations.

On the other hand, it is also true that herpetiform manifestations are often associated with other autoimmune pathologies (pernicious anemia, type 1 diabetes, or disorders affecting the thyroid gland).

The genetic footprint and predisposition, in any case, always play a paramount role in the etiopathogenesis of dermatitis herpetiformis: therefore, this skin manifestation and celiac disease show the same genetic sensitivity (the genes involved are the same) and in both diseases gluten is responsible for the autoimmune reaction.

Immune reactions are controlled antigenic system identification called HLA ( human leukocyte antigen), fundamental to the proper functioning of defense systems: when the genes that control this system are changed, the likelihood that the subject will be affected by one or both diseases is very high; in particular, patients with celiac disease tend to have a specific HLA gene.

To better understand: as a result of genetic predisposition and its interaction with other unknown factors, both in the manifestation of Dühring's dermatitis herpetiformis and in celiac disease, there is a lack of recognition by the immune system of some of the body's own structures. In dermatitis herpetiformis, antibodies attack the skin, causing damage to keratinocytes (skin cells), while in celiac disease, the attack occurs in the intestinal mucosa.

Symptoms of Duhring's dermatitis herpetiformis

Duhring's dermatitis herpetiformis manifests itself at the skin level with the appearance of itchy rashes and obvious erythematous spots (see photo above), accompanied by irritation and inflammation: the course, of course, is not natural, since the immune system itself causes a reaction.

The rash is usually preceded by intense itching or burning sensations that often occur at the level of the elbows, knees, lower back, and even the scalp.

The dermatitis can progress and cause blisters and blisters on the body of small size: lesions at the level of the skin, however, do not go unnoticed, since the subject is constantly subjected to a fierce and unbearable itch that cannot be ignored and the person constantly has to scratch and rub the itchy area. In this case, skin irritation worsens exponentially, blisters and blisters rupture, followed by the formation of scabs, ulcers, erosions and scars. In some cases, even slight bleeding may occur.

The rash itself progresses slowly but inexorably: at first small blisters appear, scattered over precise areas of the body, which then evolve into more serious forms, sometimes affecting the entire surface of the body; the sites most susceptible to dermatitis herpetiformis are the legs, arms, and back, although a rash may also appear on the face and scalp.

When the crusts disappear, scars remain: in these areas, the skin may undergo chromatic changes (hypopigmentation or, less commonly, hyperpigmentation) compared to undamaged skin.

In rare cases, the disease may regress until it finally disappears.

In addition, in most cases, people suffering from Duhring's dermatitis herpetiformis also show intestinal symptoms, such as abdominal pain, usually aggravated by the intake of foods containing gluten, precisely because of the direct correlation with celiac disease.

Diagnostics

Diagnosis of dermatitis herpetiformis is quite difficult, as it is often confused with others, such as herpes zoster(a condition known as "") or eczema. The patient should immediately contact a specialist who will have to perform biopsy(an invasive test that involves removing and analyzing a piece of tissue) related looking for antibodies which caused the problem to shed light on the origin of the disease.

A small piece of healthy skin tissue is taken from the patient and analyzed in the laboratory under a microscope: if the analysis is positive in the presence of specific IgA, then it is believed that the patient may be suffering from Dühring's dermatitis.

IgA are antibodies which belong to the immune system: at the intestinal level, type A immunoglobulins are necessary to protect against attacks by pathogenic microorganisms; if IgA binds to certain skin tissues, dermatitis can occur as the cells of the immune system turn against the body itself.

Further diagnosis is carried out through a blood test: the antibodies responsible for gluten intolerance are also found in the blood. Antibodies that can be identified include:

anti-endomysial;
antigliadin;
tissue antitransglutaminase antibodies.

Patients with celiac disease show intestinal villus atrophy associated with folic acid and iron deficiency: patients suffering from dermatitis herpetiformis show the same conditions, so it is advisable to look for any possible disadvantages of these substances for a thorough diagnosis of dermatitis.

Assessment of the disease is absolutely essential: if an accurate diagnosis has not been established, it is impossible to carry out definitive therapy.

Treatment and prevention of Dühring's dermatitis

As is the case with many diseases that affect humans, the best treatment currently available to combat Duhring's dermatitis herpetiformis is prevention.

More precisely, in the specific case of Dühring's dermatitis, prevention should be carried out by following a specific diet, which can be combined with possible pharmacological treatment to alleviate the typical symptoms of the disease.

Diet for dermatitis herpetiformis

To prevent the appearance of skin manifestations of dermatitis herpetiformis Duhring - but also the same celiac disease - it is very important to follow a specific diet, which should be completely free of products containing gluten.

A gluten-free diet is, in fact, the only possible treatment capable of completely eliminating triggering factors. If this is not enough, following the advice of a doctor, certain medications can be used.

Pharmacological treatment

If a gluten-free diet is not enough to prevent DH, the doctor may prescribe certain medications to help control the symptoms of the disease.

In this regard, the active ingredients commonly used are: Dapsone(preferential therapy) and Sulfapyridine(less effective alternative treatment compared to the previous one). As a rule, these drugs act quite quickly, so - in most cases - the symptoms disappear after a few days of treatment.

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Dermatitis herpetiformis (Dühring's dermatitis) is a chronic skin disease. It is manifested by redness and swelling of certain areas of the skin, a rash in the form of vesicles, blisters and papules, accompanied by burning and itching. Dühring's dermatitis is called herpetic dermatitis because the rash clusters exactly as with herpes. In order to identify the disease, a histological examination and analysis of the contents of the vesicles by direct immune fluorescence are prescribed. For treatment, drugs of the group of sulfones and corticosteroids are used.

Features of Dühring's dermatitis

The risk group for this disease is not defined, dermatitis herpetiformis occurs in patients of any age and gender. But most often it is diagnosed in middle-aged men. In some cases, this is a skin reaction to malignant tumor, that is, the paraoncological form. But more often the cause of the disease are factors typical for dermatological diseases. How the areas of skin affected by Dühring's dermatitis look can be seen in the photos below.

This type of dermatitis differs from most dermatological diseases in a variety of rashes. On the skin, you can simultaneously observe blisters and papules, vesicles and spots.

Characteristic signs of Dühring's dermatitis:

Spots. They appear first of all, have clear contours and a smooth surface, in their place blisters, papules and vesicles form.
blisters. After 3-4 days they burst, after a while they become covered with crusts.
papules. Small, bizarre seals with bright red borders.
bubbles. They are filled with a clear (sometimes turbid) liquid and have a diameter of 2 to 20 mm.

Rashes are observed on the shoulders, elbows, lower back, buttocks and legs, very rarely - on the oral mucosa. The affected areas are symmetrical, the skin may not change in appearance, but may become swollen or reddened. The disease has general symptoms. This is weakness and slight tingling in the places of rashes, severe itching and burning, slight fever and loose stools, insomnia or drowsiness, disorders of the thyroid gland and other organs.

Causes of Dühring's dermatitis

The causes of Dühring's dermatitis have not yet been established, the disease is considered unpredictable. The main factors that provoke the disease are similar to those that cause other dermatological diseases. This:

genetic predisposition.
Weak immune defense.
Viral infections.
Pregnancy.
Hormonal disorders.
Stress, excessive mental stress.
Intolerance to foods containing gluten.
The presence of cancer cells in the body.
Violation of the digestive tract.
Worms.

Despite the identified factors, most doctors believe that Dühring's dermatitis herpetiformis refers to autoimmune pathologies (diseases associated with impaired functioning of the immune system).

Dermatitis Duhring in children

Most often, the disease is diagnosed in male patients aged 15 to 60 years, women get sick less often, children - in exceptional cases. As a rule, it is an itchy rash that quickly spreads throughout the body. Dermatitis herpetiformis in children develops for the same reasons as in adults, is accompanied by the same symptoms, and is treated with the same drugs. If a child has symptoms of dermatitis, you should contact a pediatrician or dermatologist as soon as possible, who will prescribe the studies necessary for diagnosis and treatment.

In order to confirm the diagnosis, an external examination is not enough. Therefore, the doctor prescribes a number of studies:

Clinical blood test.
Examination of fluid from bubbles and blisters.
Histology.
Skin examination by immunofluorescence method.
Biopsy.
Thyroid examination.

The most accurate method is the Yadasson test (for sensitivity to iodine). The Jadasson test is named after the German doctor who developed this method. It consists in the following: a compress with an ointment based on potassium iodide is applied to the skin area. If after a day rashes or redness appear at the site of the compress, it can be argued that the patient has dermatitis herpetiformis.

Treatment of Dühring's dermatitis

Treatment of Dühring's dermatitis in adults is a complex of measures that combines medication and a gluten-free diet. Most of all gluten is found in cereals, so bakery and pasta, porridge based on wheat, rye, oats and barley, legumes, cabbage, kvass, coffee, beer, desserts are excluded from the diet. If the disease proceeds without complications, the doctor prescribes drugs from the group of sulfones - Sulfapyridine, Diucifon or Dapsone. If the course of the disease is more severe, drugs of the corticosteroid group are prescribed - Dexamethasone, Prednisolone or Methylprednisolone. In order to reduce itching, they take antihistamines - Claritin, Citrine or Erius, to strengthen the body - vitamin complexes - Neurovitan, Supradin or Vitrum.

In addition to tablets, topical agents are used - the rash is treated with fucorcin or methylene blue, hormonal ointments, suspensions, and sprays are used. To relieve inflammation, apply compresses with a solution of potassium permanganate.

As an additional treatment, folk remedies are used:

Hypericum oil. Grind 30 g of leaves and flowers of St. John's wort, pour 200 ml of vegetable oil. Leave to infuse for 1.5-2 weeks. Filter, lubricate the affected areas of the skin 2-3 times a day.
Ointment based on St. John's wort. St. John's wort juice boil in a water bath until thickened, let cool. Mix with butter in a ratio of 1:4. The ointment softens the skin, heals wounds, disinfects and destroys microbes.
A decoction of birch buds. Pour 1 cup of birch buds with 300 ml of water, put on fire, bring to a boil. Hold on fire for 15 minutes, let cool, strain. Wipe the rashes 3-5 times a day. The decoction soothes, relieves itching and inflammation.
Melissa tea. Brew 1-2 teaspoons of lemon balm in 200 ml of boiling water, let cool. You can drink at any time, 2-3 times a day, after meals instead of tea. The tool has anti-inflammatory and tonic properties.

A doctor should select a treatment regimen and prescribe medications; self-medication can lead to infection with a secondary infection and the transition of dermatitis to a severe form.

Complications of Dühring's dermatitis

In order for dermatitis herpetiformis not to cause complications, the doctor monitors the course of treatment and periodically prescribes tests. In some cases, the disease is accompanied by nausea and vomiting, in severe cases, inpatient treatment is required. If this is not the case, dermatitis will turn into a more dangerous form for health, and the risk of contracting a secondary infection will increase significantly. Acute periods will alternate with remission, dragging on for several months. The patient will suffer from itching and burning, and his skin will take on a repulsive appearance. The person will worry about his appearance, reduce communication to a minimum, lose sleep and appetite. As a result, mental health disorders and prolonged depression.

Prevention of Dühring's dermatitis

Dühring's dermatitis in adults is a chronic disease, complete recovery is observed in exceptional cases. If you are predisposed to illness, follow these simple rules:

Follow a gluten-free diet.
Avoid foods high in iodine.
Take iodine-containing medicines under medical supervision.
Ensure yourself a good rest and healthy sleep.
Walk outside regularly.
Avoid stress, overheating and hypothermia.
Lead a healthy, active lifestyle.

Unfortunately, Dühring's dermatitis is often accompanied by severe relapses, especially dangerous for the elderly. But it is impossible to predict the course of the disease and the course of treatment. Only a timely appeal to a dermatologist, complex therapy and following the recommendations of the doctor will allow you to get rid of the disease and return to full life. The disease is difficult to treat, so it requires a lot of patience and a positive attitude.

Causes

Symptoms

Localization of rashes

Unpleasant signs

Diagnostics

Therapeutic measures

Medicines for treatment

Folk methods

Complications

Proper Diet

Prevention

Conclusion

Causes

89. Neurodermatosis. Etiology and pathogenesis. Classification. Clinical characteristics of limited and diffuse neurodermatitis. Differential diagnosis. Treatment.

Features of the clinical course in children

Other signs of skin disease

Symptoms

The nature of the flow

Diagnostics

Gomel State Medical University

Differential Diagnosis

Treatment of Duhring's disease

Folk remedies

Traditional medicine methods

Medications

Are folk recipes effective?

Prevention

Forecast

Diet for dermatitis

Dermatitis herpetiformis Duhring 8 photos with a description

Causes of dermatitis herpetiformis Duhring

Symptoms of Duhring's dermatitis herpetiformis

There are forms, the most common:

It is possible to distinguish the general characteristic signs of herpetiform dermatitis:

Treatment of dermatitis herpetiformis Duhring

The following medications are prescribed:

Treatment of Dühring's dermatitis herpetiformis with folk remedies

Prevention of dermatitis herpetiformis Duhring

Epidemiology

Causes

Symptoms of Duhring's dermatitis herpetiformis

Diagnostics

Treatment and prevention of Dühring's dermatitis

Diet for dermatitis herpetiformis

Pharmacological treatment

Features of Dühring's dermatitis

Characteristic signs of Dühring's dermatitis:

Causes of Dühring's dermatitis

Dermatitis Duhring in children

Treatment of Dühring's dermatitis

As an additional treatment, folk remedies are used:

Complications of Dühring's dermatitis

Prevention of Dühring's dermatitis

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