eMedicine Specialties > Dermatology > Bullous Diseases

Dermatitis Herpetiformis: Follow-up

Author: Jami L Miller, MD, Assistant Professor, Division of Dermatology, Department of Internal Medicine, Vanderbilt University Medical School; Director of Phototherapy Unit, Vanderbilt University Medical Center; Consulting Attending Physician, Nashville Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Aug 14, 2009

Follow-up

Further Outpatient Care

Complications

  • Complications are related to the gluten-sensitive enteropathy, the risk of developing lymphomas, and the potential adverse effects of medications, particularly dapsone.

Prognosis

  • Dermatitis herpetiformis (DH) is an ongoing disease process of variable severity.
  • The prognosis is good for patients who can tolerate dapsone and the few who can maintain a gluten-free diet (which may decrease the risk of lymphoma).

Patient Education

  • Educate patients regarding the use of a gluten-free diet as well as the adverse effects and complications of dapsone.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider and diagnose dermatitis herpetiformis can result in the continuation of a distressing disease in a patient who can be treated successfully with dapsone.
  • Failure to mention the association of dermatitis herpetiformis with gluten sensitivity and the association with lymphoma can result in further distress to the patient. Although maintenance of a gluten-free diet demands a motivated patient, it should always be offered as an option.
  • Patients must be monitored when using dapsone or sulfapyridine. Very commonly, patients' hemoglobin levels drop by 1-2 g/dL during dapsone therapy, and larger decreases may be seen. Patients should be counseled regarding the signs of a pronounced hemolytic anemia or methemoglobinemia, including malaise, shortness of breath, tachycardia, or jaundice. Most patients can continue the dapsone if the anemia is mild and they are asymptomatic.

Special Concerns

  • Polymorphic lesions and an atypical presentation, including a paucity of the characteristic vesicles, may make clinical diagnosis difficult.
  • Histopathologic and immunologic confirmation of clinically suspected disease is mandatory for diagnosis.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Kristina Collins, MD, and Hunter Sams, MD, to the development and writing of this article.



More on Dermatitis Herpetiformis

Overview: Dermatitis Herpetiformis
Differential Diagnoses & Workup: Dermatitis Herpetiformis
Treatment & Medication: Dermatitis Herpetiformis
Follow-up: Dermatitis Herpetiformis
Multimedia: Dermatitis Herpetiformis
References
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Further Reading

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Keywords

dermatitis herpetiformis, Duhring's disease, Duhring disease, autoimmune blistering disorders, autoimmune blistering diseases, gluten sensitive enteropathy, gluten-sensitive enteropathy, GSE, herpetiform eruption.

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Contributor Information and Disclosures

Author

Jami L Miller, MD, Assistant Professor, Division of Dermatology, Department of Internal Medicine, Vanderbilt University Medical School; Director of Phototherapy Unit, Vanderbilt University Medical Center; Consulting Attending Physician, Nashville Veterans Affairs Medical Center
Jami L Miller, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Russell Hall, MD, Chief, Professor, Department of Internal Medicine, Division of Dermatology, Duke University
Russell Hall, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, American Society for Clinical Investigation, and Society for Investigative Dermatology
Disclosure: Genetech Grant/research funds Principle Investigator; Centecor  Grant/research funds Principle Investigator

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis  investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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