The treatment of Dermatitis herpetiformis is ?
A. i.e. Gluten free diet with minerals and vitamins Dermatitis herpetiformis is associated with subclinical gluten sensitive enteropathy and HLA B8 halotypeQ. It presents with severely pruritic (itchy) papulovesicular/uicarial lesions and crusted papules & excoriation symmetrically distributed over extensor surfaces (i.e. elbows, knees, buttocks, back, scalp & posterior neck) Q. On DIM, there is granular deposition of IgA autoantibodies (directed against epidermal transglutaminase) in papillary dermis (dermal papilla) and epidermal basement membrane (dermo-epidermal junction). Strick gluten free diet, Atkins diet and elemental diet is treatment of choice and dapsone is drug of choiceQ. Disease Dermatitis herpetiformis Pemphigus vulgaris Bullous pemphigoid Numular (Disci. Feature Eczema Age (mainly) Adults (20-40 yr) Adults (30-60 yr)Q Elderly (>60 to 80 yr) Q Middle age & elderly Area of predeliction Symmetrically over - Asymmetrical on - Symmetrical on lower Lower extremities (distribution) extensor surfaces (i.e. upper half of body half of body (limbs > (mc), upper elbows, knees, buttocks, back, scalp & posterior (trunk > limbs) i.e. scalf, face, neck, axilla trunk) i.e. flexural aspects of limbs & extremities and trunk neck) Q & trunk central abdomens Q - Oral mucosa commonly involvedQ - Mucosa not involvedQ Itching (pruritis) Intensely pruritic (itchy) with a burning/stinging component Mild in early cases Itching is common & may persist for months Intense itching Lesion Severely pruritic Painful, mostly - Uicarial/eczematous Minute vesicle & papulovesicular / uicarial lesions and nonpruritic, fragile, flaccid (thin wall prodrome (preceding 3 weeks to months) f/b papules enlarge to form characteristic crusted papules & delicate) bullae Q on a faint, dusky erythema in erythematous excoriation Q normal or erythematous base that rupture to produce extensive denudation. a figurative pattern. - Large (many cm), tense, tough, dome shaped blisters that may remain intact for several days and the contents often becoming jelly like coagulated fibrin or occasionally blood stained scaling coin shaped area Q. Associated with - Gluten sensitive enteropathy (absorptive defect) HLA- B8/DRW3/DQW2 halotype Q Mn: "Row MAN" i.e. Row MAN absent row of tombstone appearance, mucosal involvement acantholysis & - Thyroid abnormalities Nikolysky sign present (mostly hypothyroid), achlorhydria, atrophic gastritis, SLE, RA, UC, myasthenia gravis and gastrointestinal NHL General health Fair Deteriorates Fair Fair Histopathology (of - Subepidermal bullae - Intra epidermal - Subepidermal bullae lesion) - IgA & neutrophills in bullae with without acantholysis Q papillary tip (papillary acantholysis Q - Subepidermal collection tip absecss) - IgG & C3 deposition of IgG, C3, eosinophils & - Paial villous atrophy (on small intestine biopsy) between epidermal cells in fishnet pattern polymorphs Management Gluten free diet, (TOC) and dapsone (DOC) Q Systemic steroid, immunosuppressant and Mx of burn Systemic steroid, immunosuppressant and Mx of burn Topical steriod
Gluten free diet with minerals and vitamins
Carbamazepine
Acyclovir
Coicosteroids