Dermatitis herpetiformis diet
Thus, all patients with DH have associated CD although it could be described as latent CD in the majority. However, if scratched, crusting appears on the surface. The most common areas are the elbows, knees, back of the neck, scalp, upper back, and the buttocks. The name was descriptive, dermatitis being inflammation of the skin and herpetiformis meaning group. The skin symptoms usually predominate over intestinal symptoms. Like celiac disease, patients may have nutritional deficiencies. The inside of the mouth is rarely affected. DH is a persistent condition and only approximately 10% of patients have a spontaneous permanent remission. The eruption is extremely itchy and may keep patients awake at night. This was confirmed by showing the enteropathy cleared with gluten withdrawal from the diet and recurred when gluten was reintroduced. The diagnosis of dermatitis herpetiformis is made by a simple skin test. DH may be present at any age but most commonly begins between the ages of 15-40. The prevalence of DH is about 10 cases per 100,000 population. The following article, written by Lionel Fry, Emeritus Professor of Dermatology, first appeared in the Summer 2001 Edition of the Crossed Grain, the official magazine of Coeliac UK, and is reproduced here with their kind permission. The first suggestion that patients with DH also have an enteropathy identical to coeliac disease (CD) was made in 1967. About 10-15% of patients with celiac disease have DH. DH can be diagnosed with a biopsy taken from uninvolved skin adjacent to blisters or erosions.
The burning or stinging sensation can be very intense. It is a chronic skin condition with a characteristic rash with intense itching and burning sensations. It was subsequently shown that all patients with DH have evidence of a gluten enteropathy. It is slightly more common in men than females at a ratio of 3:2. Resources for people who need to eat gluten free. Serological tests for celiac disease may be negative. Laboratory tests should be performed including complete blood count, iron studies, albumin, alkaline phosphatase, folate, phosphate, calcium and vitamin D, as appropriate for each patient. However, in the majority of patients the enteropathy is mild and does not give rise to symptoms such as abdominal pain, weight loss and diarrhoea. A new unscratched lesion is red, raised, and usually small, with a tiny blister in the center. The vast majority of patients will also have features of celiac disease (villous atrophy) and do not require a small intestinal biopsy to confirm the diagnosis. Genetic factors, the immune system, and a sensitivity to gluten play a role in this disorder. Onset is most frequently in the second to fourth decade of life. Dermatitis herpetiformis (DH) was first described as a distinct clinical entity in 1884 by an American dermatologist, Louis Duhring. The typical features are small grouped itchy blisters, often on red plaques, situated on the back of the elbows and forearms, buttocks and front of the knees. Although these are the common sites the rash may in addition, occur anywhere on the body including face, scalp and trunk. Role of gluten and association to coeliac disease. It is a rare disease in the UK with the incidence being approximately 1:15,000.
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