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Blistering diseases in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
The treatment of dermatitis herpetiformis is two-fold. First, patients should initially be treated with dapsone unless this is contraindicated51,55, a major contraindication being glucose-6-phosphate deficiency. However, cimetidine can be prescribed with dapsone to help reduce the hemolytic side-effects55. The starting dose should be 100 mg/day with a maintenance dose of 25–200 mg/day53,55. Other effective combinations include tetracycline and nicotinamide56. The second treatment modality is elimination of gluten from the diet. After a prolonged gluten-free diet patients can eventually be weaned off all systemic drugs, including dapsone, and recurrence of the disease can be prevented57,58.
Serodiagnostic Tests in Dermatitis Herpetiformis
Published in Tadeusz P. Chorzelski, Ernst H. Beutner, Vijay Kumar, Tadeusz K. Zalewski, Serologic Diagnosis of Celiac Disease, 2020
Tadeusz P. Chorzelski, Ernst H. Beutner, Ewa Maciejowska, Vijay Kumar, Danuta Rosinska, Jadwiga Sulej
The dose-dependent nature of the responses of the gut mucosa to gluten challenge in dermatitis herpetiformis patients, as shown in Figures 4A and B, may be related to the studies performed by Weinstein.38 Multiple gut biopsies (more than 70 specimens) in each of two dermatitis herpetiformis cases were performed at several selected time intervals, before and after gluten challenge. While some focal variation did occur in the severity of the gut pathology at given times, these data unequivocally demonstrate the dose-response relation between the gluten challenge and the changes in the intestinal mucosa. Similarly, Andersson et al.1 examined the relation between dietary gluten and gut morphology in 45 dermatitis herpetiformis patients. Although they examined only a single gut biopsy specimen in each case, they found a significant (p <0.001) correlation between gluten intake in the diet and the morphology of the jejunal mucosa. The dose-response relationship of gut mucosa to gluten challenge reported in dermatitis herpetiformis patients is comparable to the one seen in celiac disease, as reported by Doherty and Barry.13
Practice Paper 5: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Dermatitis herpetiformis is a blistering, intensely itchy rash that develops on the extensor surfaces. It is associated with coeliac disease and is treated with dapsone. There are many cutaneous features of gastrointestinal disease, including the following: Malabsorption: Ichthyosis (dry, scaly skin), eczema, oedemaLiver disease: Jaundice, spider naevi, palmar erythema, leukonychiaRenal failure: Itching, half white and half red nailsCrohn’s disease: Perianal abscess, fistulae, skin tags, aphthous ulcersUlcerative colitis: Erythema nodosum, pyoderma gangrenosumSarcoidosis: Erythema nodosum, lupus pernio (purple indurated lesions)
Risk of vascular diseases in patients with dermatitis herpetiformis and coeliac disease: a long-term cohort study
Published in Annals of Medicine, 2023
Noora Nilsson, Joonas Leivo, Pekka Collin, Inka Koskinen, Katri Kaukinen, Heini Huhtala, Johanna Palmio, Timo Reunala, Kaisa Hervonen, Teea Salmi, Camilla Pasternack
Coeliac disease is a common immune-mediated intestinal disorder driven by dietary gluten in genetically predisposed individuals [1]. Gastrointestinal symptoms, such as diarrhoea and abdominal pain, are considered to be the classic symptoms of coeliac disease, but the disease may also present with a variety of extraintestinal symptoms [1]. Dermatitis herpetiformis (DH), a cutaneous manifestation of coeliac disease, typically presents as a pruritic, blistering, and papular rash [2]. In DH patients, granular immunoglobulin A (IgA) deposits are seen in the papillary dermis and epidermal transglutaminase (TG3) acts as the target autoantigen [3]. In addition, patients with DH also have a coeliac-type systemic disease with circulating antibodies against tissue transglutaminase (TG2) and a varying degree of enteropathy, ranging from minor inflammatory changes to severe villous atrophy in the small bowel mucosa [2]. Regardless of the intestinal findings, DH patients rarely have severe gastrointestinal symptoms [2].
Prevention and treatment of burn wound infections: the role of topical antimicrobials
Published in Expert Review of Anti-infective Therapy, 2022
Deepak K. Ozhathil, Steven E. Wolf
Though bacterial resistance is rare, resistant gram-negative strains have been reported. In 1980, four hospitals in New York State reported an outbreak of Pseudomonas cepacia that was attributed to contaminated 10% Povidone-Iodine solutions [88]. Povidone-iodine solutions are also painful with application and can cause hypersensitivity and contact dermatitis. Furthermore, iodine absorption across large wound surfaces can cause iodine toxicity-thyroid dysfunction (hyperthyroidism), acute renal failure, hypernatremia and metabolic acidosis. For this reason, it is avoided in patients with preexisting hyperthyroidism, renal dysfunction and dermatitis herpetiformis. Caution is recommended if an iodine allergy is present, and with use in children and women who are <32 weeks pregnant or lactating. In addition, because of drug interactions povidone-iodine should be avoided in patients on lithium, sulphafurazoles or sulphonylureas. Summary: Povidone-iodine is used as a pre-surgical scrub, however, due to its adverse effect profile, it is no longer commonly used outside of the operating theatre. Furthermore, it should be diluted at least ten-fold or more due to cytotoxicity, but it remains effective even at very low dilutions.
Dapsone for the treatment of acne vulgaris: do the risks outweigh the benefits?
Published in Cutaneous and Ocular Toxicology, 2022
Selami Aykut Temiz, Munise Daye
Agranulocytosis is another hematological side effect of dapsone. Unlike methemoglobinemia, this serious side effect is due to an unpredictable idiosyncratic reaction. Factors such as drug dose, immune status, degree of malnutrition, and ethnicity are probably important determinants of the risk of developing agranulocytosis. Developing agranulocytosis is estimated in 1 out of 400 patients receiving dapsone treatment30. The risk of agranulocytosis was found 25 times higher in patients with dermatitis herpetiformis compared to other patients31. The median duration of treatment before the development of agranulocytosis is 7 weeks. This side effect rarely develops with treatments longer than 12 weeks. Patients often present with infection symptoms such as fever or pharyngitis, and rarely with sepsis. When the drug is discontinued, recovery is typical within 7–14 days if patients recover from the current infection1,31. Granulocyte colony-stimulating factor has been used successfully to accelerate hematological recovery. Patients should be followed up with complete blood counts every 2 weeks within the first 3 months of treatment. Again, when signs/symptoms of infection develop in patients using dapsone, care should be taken in terms of agranulocytosis side effects32.