Dühring dermatitis treatment diet. Chronic Dühring's dermatitis herpetiformis. Video about Dühring's dermatitis

There are many different skin conditions that people around the world face. Some of them are temporary and can go away on their own, but there are chronic diseases that often recur and cause many inconveniences, causing strong discomfort. One of these pathologies is dermatitis herpetiformis.

Description of the disease

Dühring's dermatitis herpetiformis is a type of chronic skin disease in which erythematous rashes, blisters, vesicles and papules form on it. The affected areas are very itchy. Relapses are frequent and inconvenient for patients. The disease got its name due to the fact that the rash with Duhring's dermatitis is outwardly very similar to skin rashes with herpes. Another name is pemphigoid herpes.

Erythematous eruptions can occur with many different conditions. They are reddish or pinkish spots with protruding capillaries, which can merge into a single spot if there are a lot of them. Vesicles are small bubbles of fluid on the surface of the skin. Papules are special nodules that look like small pimples and have no internal cavity.

Dermatitis herpetiformis can affect large areas of the skin

The disease is most often detected at the age of 20-40 years. Basically, Duhring's dermatitis affects men, it occurs in them twice as often as in women. Sometimes this disease accompanies patients with oncological tumors, which makes it one of the signs of the formation of cancer, and is a type of para-oncological dermatosis.

The acute stage of dermatitis herpetiformis can be followed by rather long periods of remission, which sometimes last for several years.

Forms of the disease

Depending on which type of rash manifests itself the most, several forms of Duhring's dermatitis herpetiformis are distinguished:

The last three forms are atypical and may be similar to other dermatological conditions.

Causes and factors of development

At the moment, the causes of dermatitis herpetiformis have not yet been fully understood. Scientists put forward several hypotheses about the factors in the formation of this disease:

individual intolerance to gluten protein, which is found in large quantities in cereals;
hereditary predisposition also plays a role in the onset of this type of dermatitis. If parents suffered from ailment, then the chances of getting sick are doubled in children. Which gene is responsible for this pathology is not yet known at this point;
autoimmune disorders in the body, which are indicated by a special IgA antigen found in patients in the basement membrane between the dermis and the epidermis;
sensitivity to iodine and iodine-containing products;
infection with helminths (ascariasis);
various types of diseases of the gastrointestinal tract (gastritis, ulcers);
viral lesions of the body (ARVI, herpes, etc.);
hormonal changes during pregnancy and menopause;
the body's reaction to the vaccination;
nervous and physical exhaustion of the body;
excessive sun exposure (frequent exposure to the sun).

Video about gluten intolerance in Elena Malysheva's program "It's great to live!"

Symptoms

The first signs of dermatitis herpetiformis are itching, burning, and tingling. Some patients develop paresthesia, in which a sensory disorder occurs, and some areas of the skin become numb. After about ten hours, special rashes begin to appear in the form of erythematous spots and various blisters filled with fluid. Vesicles are small in size, deeply located and very elastic due to their serous contents. Most often, the onset of the disease is acute, and all symptoms develop very quickly.

Vesicles with serous contents very often burst when combing and leave behind erosion.

Sometimes, next to the inflammation, small bruises appear in the form of small subcutaneous bruises (petechiae and ecchymosis), they are about 3 mm in size. Over time, after combing, erosion may form, which subsequently become covered with yellowish crusts. After healing, lighter areas or, conversely, pigmented areas remain on the skin. If the wounds were deep, then scars may form in their place.

Erythematous spots have a well-defined border and a round or oval shape. They can grow, merge with each other and form large patches covered with wounds, crusts and blisters. The latter can be both very small and reach a size of about two centimeters, turning into bullous blisters. They are filled with a clear liquid that can become cloudy if an infection occurs.

Usually, rashes are found on the following areas of the body:

extensor surface of the limbs;
gluteal region;
sacrum;
scalp;
face;
shoulder blades;
shoulders;
small of the back.

In general, all areas of the body can be affected except the soles of the feet and palms. The mucous membrane is rarely affected, but some patients may have blisters in the mouth, which quickly develop into erosive areas that do not heal for a long time.

Vesicles and blisters are usually yellowish in color due to serous contents

Diagnostics and differential diagnostics

There are several ways to diagnose dermatitis herpetiformis. The doctor may prescribe the following procedures:

Jadasson's iodine test is to study the response of the patient's body to an irritant. The doctor selects an area of the skin that is not affected by the disease and applies a lotion soaked in 50% potassium iodide on it. After a day, the compress is removed, and if redness, bubbles or papules are found under it, this indicates Duhring's dermatitis. If there is no reaction, the procedure is repeated, but the already healed area of the skin is used, on which pigmentation remains after the rash. In rare cases, iodine intake may be prescribed by mouth, but this can lead to serious consequences.
Complete blood count and cytological analysis of the contents of the blisters. With dermatitis herpetiformis in a patient, the results obtained will significantly overestimate the content of eosinophils, special leukocytes.
Histological examination of the affected areas of the skin. This disease is characterized by the detection of special cavities under the epidermis, in which eosinophils, neutrophils and their cleavage products accumulate.
The direct immunofluorescence test is prescribed to detect immunoglobulin A (IgA) on the dermal papillae.

Differential diagnosis is carried out in order to exclude Lever's disease (bullous pemphigoid), pemphigus vulgaris, herpetic vesicular dermatitis, toxidermia bullous, Haley-Haley benign pemphigus, subcorneal pustulosis, exudative erythema.

Since Duhring's dermatitis can be a para-oncological disease, patients can be prescribed an additional examination of internal organs using ultrasound, X-ray, magnetic resonance imaging or computed tomography.

Treatment of the disease

When the first symptoms appear, you should consult a dermatologist. After collecting all the tests, the doctor will prescribe an individual treatment, which will depend on the patient's history and concomitant diseases.

Drug therapy

There are several types of drugs that are prescribed for dermatitis herpetitis:

Antileprotic drugs included in the sulfonamides group. They disrupt the process of folate synthesis in microbial cells, have an antibacterial effect and suppress the development of Duhring's dermatitis. These drugs are quite serious and can cause many side effects. These include Diaphenylsulfone, Diucifon, Dapsone, Sulfasalazine, Solusulfone and some others.
Corticosteroids are prescribed when sulfone therapy is ineffective (Prednisolone, Dexamethasone, etc.).
Antihistamines are necessary to eliminate itching and swelling (Zodak, Loratadin, Cetirizine).

For local treatment, a solution of potassium permanganate, corticosteroid ointments, erosion treatment with greenery and fucorcin are used.

In the case of a bullous form, the blisters are opened. The procedure is performed with extreme care so as not to damage the bottom of the bladder. Otherwise, erosions will appear that require surgical treatment.

Medicines - photo gallery

Zodak - antiallergic agent of the 2nd generation with a prolonged effect Prednisolone - a synthetic glucocorticoid drug Sulfasalazine - a drug with antimicrobial and anti-inflammatory properties

Diet and nutrition

During the treatment of Duhring's dermatitis, the patient should be excluded from the diet of all kinds of products that contain iodine. It can be:

seafood;
seaweed;
some types of fish;
feijoa;
dried apricots;
chicken yolks;
potato;
iodized salt.

Also, you can not eat gluten-containing cereals and all dishes prepared from them:

wheat;
barley;
oats;
rye.

Iodine is found in large quantities in sea fish

In addition to the above products, it is worth excluding:

kvass, beer and beer drinks;
coffee substitutes;
chocolate, sweets, ice cream;
breaded semi-finished products;
smoked and pickled products;
sausages.

Video about a gluten-free diet from the Union of Pediatricians of Russia

Folk remedies

Folk remedies can be used only after consulting a doctor, since even herbal preparations, despite their seeming harmlessness, can cause complications.

For Duhring's dermatitis herpetiformis, herbs that have anti-inflammatory and antihistamine effects are suitable. These include calendula, juniper, licorice, sea buckthorn.

Calendula has anti-inflammatory, antiseptic, healing properties

To strengthen the immune system, pharmacy tinctures from Eleutherococcus and ginseng are suitable.

Herbal tincture

The use of this recipe helps to eliminate germs and bacteria, dry wounds and relieve inflammation.

Take one teaspoon each of juniper, tansy, nettle, calendula, and yarrow.
Pour the resulting mixture with 0.5 liters of vodka.
Place the liquid in a glass jar and place in a dark place for 10-15 days.
Strain the tincture.
Wipe the affected skin area once a day.

The course of the procedures is individual and takes, on average, about 5-10 days.

Physiotherapy

As a rule, physiotherapeutic treatment is not prescribed for this pathology. It is possible to carry out X-ray therapy if the use of medicines is ineffective.

Treatment prognosis and possible complications

It is extremely difficult to recover from dermatitis herpetiformis, it usually proceeds in a chronic form. The disease often recurs, especially if the diet and doctor's recommendations are not followed. The main complication that can arise is secondary infection due to bacteria getting on open wounds.

Prevention

There are no specific preventive measures to prevent dermatitis herpetiformis. If the patient knows about the sensitivity of his body to gluten and iodine, then he should avoid foods that contain these substances throughout his life in order to exclude relapses of the disease.

It is also important to improve sleep patterns, rest more, avoid overwork and stressful situations. It is worth monitoring your immunity and strengthening it in every possible way with the help of tempering or special preparations.

Among other things, it is necessary to normalize the work of the gastrointestinal tract, improve the condition of the intestinal microflora and eat less junk food.

Features of the disease in children

At a young age, treatment is sometimes not required, since very often the disease can go away on its own. Symptoms and causes of the formation of Duhring's dermatitis herpetiformis in children are the same as in adults. Treatment is similar, only in lower dosages. It is imperative to follow a diet, and if the disease appears in an infant, then the mother needs to monitor her diet. She should exclude iodine-containing foods and gluten.

Most children develop Duhring's disease after suffering infectious diseases.

Dühring's dermatitis herpetiformis is a chronic recurrent skin disease characterized by a true polymorphism of the rash (vesicles, blisters, papules, blisters, erythema) and severe itching.

Etiology and pathogenesis. The etiology is unknown. They suggest the autoimmune nature of the disease, as evidenced by the gluten-sensitive enteropathy found in the vast majority of patients and the detection of IgA deposits (antibodies against the structural components of the dermal papillae near the basement membrane) in the dermoepidermal junction during direct immunofluorescence. IgA deposits are located mainly in the form of granules at the top of the dermis papillae and inside them. In some patients, circulating immune complexes of gluten-antibodies (IgA) are also detected. Hypersensitivity to iodine and genetic predisposition play a certain role in the pathogenesis of the disease. Dermatitis herpetiformis can also be observed as para-oncological dermatosis.

Histologically, subepidermal vesicles are revealed, the serous contents of which are often rich in eosinophils. The blisters are bordered by papillary microabscesses (accumulations of neutrophilic and eosinophilic granulocytes) located at the tops of the papillae of the dermis. The blood vessels of the dermis are dilated and surrounded by infiltrates formed by neutrophils, eosinophils, destroyed nuclei ("nuclear dust") and mononuclear cells with an admixture of neutrophilic leukocytes. Over time, the infiltration becomes continuous, usually with a predominance of eosinophils. The bottom of the subepidermal bladder may gradually become covered by the regenerating epidermis.

The clinical picture. The disease occurs at any age, somewhat more often in 30-40 years. The provocative role of taking a large amount of starch and iodine, excessive insolation and viral diseases has been established. The onset is usually gradual, lasting weeks or months. The disease becomes chronic, interrupted by remissions lasting from 3 months to 1 year or more. Skin rashes may be preceded by malaise, mild fever, tingling sensation, and especially often itching. A true polymorphism of the rash is characteristic, due to a combination of erythematous spots, urticarial efflorescences, papules and vesicles, to which blisters can join. True polymorphism is complemented by false ones (erosion, excoriation, crusting). Erythematous spots are usually small, rounded, have rather clear boundaries, due to the attachment of effusion from dilated vessels, they are transformed into urticarial-like formations, prone to peripheral growth and fusion with each other into extensive foci of pink-cyanotic color, rounded, and more often scalloped or bizarre outlines with clear boundaries. Their surface is dotted with excoriation, serous and hemorrhagic crusts, vesicles, located, as a rule, in the form of rings with a diameter of 2-3 cm or more. When the infiltrate is deposited, erythematous spots transform into juicy pink-red papules with an initially smooth surface, which eventually acquire pruriginous features. Urticarial and papular rashes can occur without a preliminary erythematous stage. Vesicles of small size (2-3 mm in diameter) appear on the affected or apparently healthy skin, are distinguished by a dense cover and transparent contents, which become cloudy over time and can become purulent. When the contents of the vesicles dry out, crusts are formed, and when they are opened, which occurs most often under the influence of scratching, erosion is exposed. The vesicles, grouping, resemble a herpes rash. Bubbles have the same clinical and evolutionary characteristics as vesicles, but differ from the latter only in their large size (their diameter is from 0.5 to 2 cm or more). The rash is usually symmetrical; are located on the extensor surfaces of the arms and legs, elbows, knees and shoulders, as well as on the sacrum, buttocks, lower back, back of the neck, scalp and face. They are often grouped together. The defeat of the mucous membranes is uncommon; only occasionally vesiculobullous elements appear in the oral cavity, followed by their transition to erosion. With regression of dermatitis herpetiformis rashes, as a rule, hypo- and hyperpigmented spots remain. Subjectively, there is a strong, sometimes burning, itching, sometimes soreness. The general condition of patients during relapses can be disturbed: the body temperature rises, itching intensifies, and sleep is disturbed. Of the laboratory changes, frequent eosinophilia in the blood and bladder fluid should be noted.

The diagnosis is based on clinical findings. To confirm the diagnosis, the determination of the number of eosinophils in the blood and gallbladder fluid is used. An increased level of them in both of these fluids or in one of them testifies in favor of the diagnosis of dermatitis herpetiformis, however, the absence of eosinophilia does not exclude it; test with iodine (Jadasson test) is used in two modifications: cutaneous and inside. For 1 sq. see apparently healthy skin, better forearms, apply an ointment with 50% potassium iodide under a compress for 24 hours. The test is considered positive if erythema, vesicles or papules appear at the site of application of the ointment. In case of a negative result, 2-3 tablespoons of a 3-5% solution of potassium iodide are prescribed inside. The test is considered positive when signs of exacerbation of the disease appear. In severe dermatitis herpetiformis, an internal test can cause a sharp exacerbation of the disease, so it should not be carried out in such cases. The most reliable are the results of histological examination, which can detect the subepidermal bladder, papillary microabscesses and "nuclear dust". Particularly valuable are the data of direct immunofluorescence, revealing in the area of the epidermal-dermal junction IgA deposits located in granules or linearly. The differential diagnosis is carried out with bullous pemphigoid, pemphigus, bullous toxidermia.

Treatment: patients with dermatitis herpetiformis are subject to examination for concomitant diseases, primarily gastrointestinal, focal infection, cancer, especially with atypical forms of street disease of the elderly and old age. Diet is important: products containing iodine and gluten are excluded from the diet. The most effective sulfonic agents are: diaphenyl sulfone (SDS, dapsone, avlosulfone), diucifon, sulfapyridine, etc. Usually, diaphenyl sulfone or diucifon is prescribed at 0.05–0.1 g 2 times a day in cycles of 5–6 days at intervals of 1–3 days ... The course dose depends on the effectiveness and tolerability of the drug. With the resistance of the clinical manifestations of dermatitis herpetiformis to sulfone drugs, corticosteroid hormones are shown in average daily doses. Locally, warm baths with potassium permanganate are prescribed; bubbles and bubbles are opened, then treated with fucorcin or an aqueous solution of dyes; 5% dermatol ointment; corticosteroid ointments and aerosols.

Chronic recurrent skin lesions, manifested by a polymorphic rash in the form of erythematous spots, blisters, papules, blisters and accompanied by severe itching and burning. The disease got its name due to the fact that the elements of the rash with Dühring's dermatitis are grouped in the same way as the rash with herpes. Diagnostics is carried out using histological examination, analysis of the contents of the blisters and the reaction of direct immunofluorescence. In the treatment of Duhring's dermatitis herpetiformis, the sulfone group of drugs and corticosteroids are effective.

General information

Dühring's dermatitis herpetiformis occurs at any age, but most often it develops in 30-40 years. Men are more susceptible to this disease than women. In some cases, Duhring's dermatitis herpetiformis is a skin reaction to a malignant tumor of internal organs in the body, that is, it acts as a para-oncological dermatosis.

Causes of occurrence

The causes and mechanism of development of Duhring's dermatitis herpetiformis are unknown. Many patients have an intolerance to the glutein protein found in cereals. The detection of IgA antibodies at the border of the dermis and epidermis, in the area of the basement membrane, speaks in favor of the autoimmune component in the development of the disease. It is assumed that a certain role in the occurrence of Duhring's dermatitis herpetiformis is played by increased iodine sensitivity, heredity, ascariasis, inflammatory processes of the gastrointestinal tract (gastritis, peptic ulcer), viral diseases (ARVI, herpes infection, etc.).

Symptoms

Usually, Duhring's dermatitis herpetiformis has an acute onset with the appearance of foci of polymorphic rash. Rashes may be preceded by a moderate rise in body temperature, general weakness, itching and tingling sensations. Elements of a rash can occur on any part of the skin, except for the soles and palms. But their most common location is the extensor surfaces of the arms and legs, the area of the shoulder blades, shoulders, lower back and buttocks. On the palms, petechiae and ecchymosis can occur - large (more than 3mm) spots of intradermal hemorrhage. The rash is accompanied by severe discomfort: a burning sensation, intense itching and paresthesia. The defeat of the mucous membranes in Duhring's dermatitis herpetiformis, as a rule, is absent. In rare cases, blisters may appear in the oral cavity, quickly turning into erosion.

The true polymorphism of the rash in Duhring's dermatitis herpetiformis is associated with the simultaneous appearance on the skin of various sizes of erythematous spots, blisters, papules and blisters. Over time, a false one joins the true polymorphism: erosion and crusts associated with the transformation of rashes are formed, as well as excoriation caused by strong scratching of the skin. When the elements of the rash heal, foci of hypo- and hyperpigmentation, sometimes scars, remain on the skin.

Erythematous spots in Duhring's dermatitis herpetiformis have a clear outline and a rounded shape. Their smooth surface is often covered with scratches, bloody and serous crusts. Over time, they become saturated with effusion from the dilated vessels and turn into blister-like (urticarial) formations. The latter grow on the periphery and merge, transforming into pink-cyanotic foci covered with crusts, scratches and bubbles. Along with this, erythematous spots can turn into juicy pink-red papules. In addition, the appearance of papules and urticarial-like rashes can occur without the stage of the erythematous spot.

Bubble elements of the rash in Duhring's dermatitis herpetiformis can be small in size - vesicles and more than 2 cm in diameter - bullous rashes. They are filled with a clear liquid, the turbidity of which indicates an infection. Bubbles break open and dry to form a crust. Due to scratching, the crust is removed and erosion remains in the place of the bubble.

Depending on the predominance of a particular type of rash over the rest, the following types of Duhring's herpetiform dermatitis are distinguished: papular, vesicular, bullous and urticarial. Atypical variants of the disease are possible: trichophytoid, eczematoid, strofuloid, etc.

Acute periods of Duhring's dermatitis herpetiformis are combined with rather prolonged remissions (from several months to a year or more). Exacerbations often occur with a deterioration in the general condition of the patient, a rise in temperature, and sleep disturbances.

Diagnostics

If you suspect Dühring's dermatitis herpetiformis, an iodine test of Jadasson is performed. A compress with an ointment containing 50% potassium iodide is applied to a healthy area of the skin. After 24 hours, the compress is removed. Identification of redness, vesicles or papules in its place speaks in favor of Duhring's dermatitis herpetiformis. If the sample is negative, then repeat it. To do this, after 48 hours, apply the same compress to the area of pigmentation left after the former rashes. The Jadasson test can be carried out with the intake of the iodine preparation inside. But such a study is fraught with a sharp exacerbation of the disease.

With Duhring's dermatitis herpetiformis, a clinical blood test reveals an increased content of eosinophils. A cytological examination of the contents of the blisters also reveals a large number of eosinophils. However, these data, like the Jadasson test, are not mandatory or strictly specific for the disease.

The most reliable way to diagnose Duhring's dermatitis herpetiformis is a histological examination of the affected skin. It reveals cavities located under the epidermis, accumulations of eosinophils, neutrophils and the remnants of their destroyed nuclei. The direct immunofluorescence (RIF) reaction detects IgA deposits on the tops of the dermal papillae of the dermatologist. Prescribe a diet that excludes cereals and iodine-containing products (sea fish, seafood, salad, etc.). Drug therapy is carried out with drugs of the sulfone group: diaphenyl sulfone, sulfasalazine, solusulfone and others. These drugs are usually prescribed by mouth in cycles of 5-6 days, with breaks of 1-3 days. In cases of ineffectiveness of sulfone therapy, treatment is carried out with medium doses of corticosteroids (prednisolone, dexamethasone, etc.). Antihistamines are used to relieve itching: loratadine, cetirizine, desloratadine.

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

Dühring's dermatitis is a skin disorder characterized by a blistering rash. Outwardly, the symptoms are very similar to the manifestations of herpes. The disease got its name by the name of a dermatologist from the USA Duhring. It was he who was engaged in the study of pathology and described in detail its symptoms. Dermatitis herpetiformis mainly affects middle-aged people. It often proceeds in a chronic form, often recurs. What is the disease, how does it manifest itself, is it treatable?

What is Duhring's dermatitis herpetiformis

Dühring's disease is a chronic relapsing skin disease. It is diagnosed at different ages, but most often it affects middle-aged people (30-40). Men are more prone to dermatitis herpetiformis than women.

Dermatitis is characterized by a varied rash (that is, elements that differ from each other in size, appearance, shape and content appear on the skin at the same time). The rash covers the trunk and limbs. Favorite places of rashes are the area of the shoulder blades, shoulders, lower back, lower legs, buttocks, elbows.

The defeat of the mucous membranes is uncommon for the disease. Very rarely, small bubbles may appear in the oral cavity, which quickly turn into erosion.

The rash is accompanied by characteristic symptoms, the main of which are:

severe discomfort;
tingling and burning.

If you constantly comb the affected area, this threatens with secondary infection. That is, a bacterial infection will join the underlying disease.

Dühring's rash appears in the form of blisters, bubbles, always arranged symmetrically (in the form of a ring, circle). On the first day, there is a clear liquid in their cavity, which begins to cloud over time. Then the bubbles burst. In their place, erosion with weeping is formed. The released liquid spreads over healthy skin. New elements appear on its surface.

Then erosion with weeping covers the yellow-brown crusts, which soon recede. In their place, light or dark spots of a round shape remain. After a while, they also disappear. A feature of Duhring's disease is the absence of rashes on the feet and palms.

Rashes are preceded by a slight increase in body temperature, general malaise, weakness, fatigue. Such dermatitis is accompanied by insomnia, impaired appetite, and the work of endocrine organs. Sometimes there is a gray staining of feces and a change in their consistency.

Dühring's dermatitis has a long and chronic course. Exacerbations are observed often and for a long time, accompanied by unpleasant symptoms that interfere with the usual way of life.

Causes of the disease

While doctors do not know the true causes of dermatitis herpetiformis. Only hypotheses are put forward.

You can only build on the factors that are to blame for its appearance:

Occasionally, a rash appears as a reaction to malignant processes occurring in the internal organs.

Physicians tend to suspect that dermatitis herpetiformis may also be of an allergic nature (due to iodine sensitivity). Also, most scientists are inclined to the version about the viral origin of the disease, since in medical practice cases of Dühring's rash have been noticed after suffering from acute respiratory viral infections, herpes infection and chickenpox.

There is a hypothesis that dermatitis causes physical and mental fatigue, severe poisoning, vaccination, which leads to a weakening of the immune system.

Is it dangerous

Dühring's dermatitis herpetiformis, as a rule, does not cause complications. If the symptoms are ignored and the disease is not treated, there is a possibility of complications in the form of secondary infections that get into scratches on the skin.

It is believed that Duhring's disease can provoke:

lupus;
vitiligo;
osteoporosis;
sarcoidosis;
intestinal lymphoma.

Do not forget that Duhring's dermatitis is a consequence of hidden processes in the body (endocrine, autoimmune, hormonal, malignant). Therefore, the disease requires detailed diagnosis and timely treatment.

Diagnostic methods

With Dühring's disease, the patient needs a thorough medical examination. The main diagnostic measures are:

Test according to Jadasson. It consists in applying a dressing soaked in potassium iodide (50%) to healthy skin. If a rash appears in a day, the diagnosis of "Dühring's disease" is confirmed. The test is carried out 2 times. After the first test, the compress is applied for 2 days.
Laboratory blood test. With such dermatitis, the patient has an increase in eosinophil counts.
Cytology. It consists in examining the contents of the bubbles. An increase in eosinophils is also observed here.
Histology. The affected area of the skin is sent for analysis. With Duhring's dermatitis, an increase in neutrophils and eosinophils is noted.
REEF. IgA antibodies are found on the dermal papillae.

Since there have been cases of detection of a rash in malignant processes of internal organs, the patient must be sent for an ultrasound scan, CT scan, and an X-ray.

Dühring's dermatitis herpetiformis treatment

Therapy for Dühring's disease is long-term. You should be prepared for this and be patient.

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

Treatment consists of an integrated approach. Not only medications are used, but also folk remedies. A nutritious diet is important in the treatment of dermatitis.

Medication

Treatment of Duhring's dermatitis is carried out using the following drugs:

Sulfone drugs (Sulfasalazine, Avlosulfone, Diaphenylsulfone, Dapsone). The drugs are effective only at the onset of dermatitis. They are taken in several courses for 5-6 days. There is a break of 1-2 days between courses. Treatment is carried out until the bubbles are completely eliminated. Since sulfones are capable of changing the composition of the blood, blood biochemistry is regularly carried out in the process of their use.
If sulfone drugs are ineffective, glucocorticosteroids are prescribed (Prednisolone, Dexamethasone).
To prevent the affected area from itching, antihistamines are prescribed - Suprastin, Zirtek.
Fukortsin, brilliant green, corticosteroids, dermatol 5% ointment are used locally.
Fortifying agents - tincture of eleutherococcus, ginseng, echinacea, lemongrass.
Gamma globulin. Injections are given 2 times a week. In total, you will need 5-6 injections.
In especially severe cases, drugs with a detoxification effect (Unithiol) are prescribed.
In isolated cases, a blood transfusion (blood transfusion) will be required.

It is obligatory for Duhring's disease to take vitamin complexes - vitamin A, group B, C, PP, folic acid. Baths based on potassium permanganate and herbal decoctions are effective.

Traditional methods

In combination with drug therapy, folk remedies are used:

Any animal fat is melted and mixed with chopped belladonna grass (2: 1). The mixture is simmering in the oven for 30 minutes. The ointment is applied to the affected skin.
Tea with lemon balm is drunk daily for a week, then take a break.
2 tbsp. l. periwinkle steamed in 400 liters of boiling water. The composition is languishing in a water bath for 10 minutes. Then it is filtered and added to the water bath.
Birch buds are placed on the bottom of a saucepan with 400 ml of boiling water. Boil over low heat for 20 minutes, then filter. A decoction of birch buds is used to wipe the skin affected by dermatitis.
A glass of fresh St. John's wort is crushed, then the juice is squeezed out. The liquid is placed in a water bath and held until it thickens. Then the juice is cooled and mixed with any animal fat (1: 4). The affected skin areas are treated with this St. John's wort ointment 3 times a day every day.

Diet

Dühring's dermatitis herpetiformis is treated with a nutritious diet. It is based on the complete elimination of gluten products.

The main task of organizing proper nutrition in Duhring's disease is the exclusion of food containing iodine and gluten. It is required to give up cereals - barley, wheat, rye, all dishes and products in which they are contained.

The following foods are removed from the diet:

rye, oats, soybeans, wheat, semolina, barley;
flour;
flour products;
confectionery products;
pasta.

Diet food is based on the use of:

vegetables, fruits in any form - boiled, baked, stewed, and also in the form of juices;
chicken, turkey meat, rabbit meat;
nuts;
baked goods based on corn, rice flour;
greens - green salad is especially useful;
seeds;
fermented milk products.

There should not be any semi-finished products, sausages, sausages, sausages on the menu of a patient with a rash Duhring. These products are replaced by meat.

In addition, iodine-rich foods should be excluded from the diet:

seafood, including seaweed;
pink salmon, perch, catfish, capelin, hake, flounder, pollock, catfish, haddock, cod, tuna;
buckwheat, millet;
Cod liver;
persimmon, grapes;
milk, cheese.

It is also not allowed to eat legumes and cabbage.

With dermatitis herpetiformis, preventive measures are very important. The main one is the diet for Duhring's dermatitis. It consists in the complete exclusion of iodine and glutein-containing products. In addition, measures to strengthen the immune system are important. To do this, you need to take vitamins (A, B, C, PP, folic acid) at least once a year. It is imperative to get enough sleep, avoid stress, hypothermia, play sports, temper, monitor your weight, and undergo regular medical examinations.

Dermatitis herpetiformis is one of the most complex and difficult to treat diseases. Therefore, it is easier to prevent it than to cure it later. To do this, you need to monitor your health, maintain immunity and eat right.

Dermatitis herpetiformis (Duhring'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 blisters, blisters and papules, accompanied by burning and itching. Dühring's dermatitis is called herpetic because the rash is grouped in exactly the same way as with herpes. In order to identify the disease, a histological examination and analysis of the contents of the vesicles by the method of 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 has not been determined; dermatitis herpetiformis occurs in patients of any age and gender. But most often it is diagnosed in middle-aged men. In some cases, it is a skin reaction to a malignant tumor, that is, a para-oncological form. But more often the causes of the disease are factors typical for dermatological diseases. How the skin areas affected by Duhring's dermatitis look can be seen in the photos below.

This type of dermatitis differs from most dermatological diseases in a variety of rashes. Blisters and papules, vesicles and spots can be observed on the skin at the same time.

Characteristic signs of Dühring's dermatitis:

Spots. They appear first of all, have clear contours and a smooth surface, in their place are formed by blisters, papules and vesicles.
Blisters. After 3-4 days they burst, after a while they become crusted.
Papules. Small, bizarre seals with bright red borders.
Bubbles. Filled with a transparent (sometimes cloudy) liquid, have a diameter of 2 to 20 mm.

Rashes are observed on the shoulders, elbows, lower back, buttocks and legs, very rarely on the mucous membrane of the mouth. The affected areas are symmetrical, the skin may not change externally, but it may become swollen or reddened. The disease also has general symptoms. These are weakness and slight tingling in 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 the appearance of Duhring's dermatitis have not yet been established, the disease is considered unpredictable. The main factors provoking the disease are similar to those that cause other dermatological diseases. It:

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

Despite the highlighted factors, most doctors believe that Duhring'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. This is usually 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 need to 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.
Study of fluid from bubbles and blisters.
Histology.
Immunofluorescence examination of the skin.
Biopsy.
Examination of the thyroid gland.

The most accurate method is the Jadasson test (for iodine sensitivity). 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.

Dühring's dermatitis treatment

Treatment of Duhring'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 sulfone group - Sulfapyridine, Diucifon or Dapsone. If the course of the disease is more severe, drugs of the corticosteroid group are prescribed - Dexamethasone, Prednisolone or Methylprednisalone. In order to relieve itching, antihistamines are taken - 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:

St. John's wort 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 skin 2-3 times a day.
Hypericum ointment. Boil the juice of St. John's wort in a water bath until thickened, let cool. Mix with butter in a 1: 4 ratio. The ointment softens the skin, heals wounds, disinfects and destroys germs.
A decoction of birch buds. Pour 1 cup of birch buds with 300 ml of water, put on fire, bring to a boil. Keep on fire for 15 minutes, let cool, drain. 3-5 times a day to wipe the area of the rash. The broth soothes, relieves itching and inflammation.
Tea with lemon balm. Brew 1-2 teaspoons of lemon balm in 200 ml of boiling water, let cool. 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 Duhring's dermatitis

In order to prevent dermatitis herpetiformis from causing 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 does not happen, dermatitis will turn into a form that is more dangerous to health, and the risk of contracting a secondary infection will increase significantly. Acute periods will alternate with remission that lasts several months. The patient will suffer from itching and burning, and his skin will take on a repulsive appearance. A person will worry about his appearance, reduce communication to a minimum, lose sleep and appetite. The result is mental health problems and lingering depression.

Prevention of Dühring's dermatitis

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

Eat a gluten-free diet.
Avoid foods high in iodine.
Take iodine-containing medicines under the supervision of a doctor.
Get plenty of rest and sleep well.
Walk in the fresh air 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 adherence to the doctor's recommendations will allow you to get rid of the disease and return to a full life. The disease is difficult to treat, and therefore requires a lot of patience and a positive attitude.