Dühring's herpetic dermatitis. Duhring's mysterious disease: treatment and prevention

There are many skin diseases in the world, the essence of which is not fully understood. One of these is considered to be dermatitis herpetiformis. This disease is characterized by a rash that closely resembles herpes. It is necessary to understand the foci of the disease, symptoms and treatment.

The average age of the disease is 35 years. Moreover, it appears more often in men.
The disease is characterized by the fact that it has too frequent repetitions, which can last up to a year. The most interesting thing is that scientists have not yet identified the specific cause of the appearance of Dühring’s dermatitis herpetiformis. Therefore, the following factors are taken as a basis:

The disease is inherited.
Formation of a tumor inside the body.
Too sensitive to iodine.
Worms in the body.
Infection or virus.
Pregnancy or menopause.
Physical and psychological fatigue can also be factors.

With dermatitis herpetiformis, the causes can be completely different. But these are the main conditions for the appearance of such a disease.

Symptoms of dermatitis

The spots are smooth, over time bubbles form in their place, all this merges together and forms a huge focus of inflammation.
Large or small blisters contain liquid inside. If there is an infection inside, the liquid is cloudy.
Over time, the blisters burst, forming erosion. When it passes, a mark or scar remains on the skin.
The rash can appear anywhere except the palms, soles, and mucous membranes. Most often on the arms, legs, shoulder blades, buttocks.
In addition to the rash, Dühring's dermatitis herpetiformis has a number of symptoms:

The rash is very itchy, tingling, and there is a burning sensation.
Body temperature rises
A man suffers from insomnia
Feeling of general weakness of the body
Gray, greasy stool
Thyroid dysfunction

When a woman is pregnant, such a disease can appear in the second trimester. You must be very careful with treatment so as not to harm the fetus.
If such symptoms appear, you should immediately consult a doctor for help.

Types of disease

Currently, there are several types of the disease:

Papular - rashes in the form of papules on the body
Bullous - the skin is covered with bullae
Vesicular - the skin is covered in vesicles
Urticariform - burns appear on the skin that resemble nettle burns
Paraoncological – a case when the development of a rash begins from the appearance of a tumor

Diagnosis of dermatitis herpetiformis

There is a very easy way to identify the disease:

The patient needs to undergo an iodine test. To do this, take petroleum jelly and potassium iodide, make an ointment, and apply it to a compress. This compress should be kept for a day on a healthy area of the body. If after a day blisters, rashes or inflammation appear on the body, the person has dermatitis. If there is nothing, then the compress is removed.
The patient must be referred for testing. Blood is donated and blisters are sampled. If a high concentration of eosinophils is found in them, the person has dermatitis herpetiformis.
An analysis is carried out for the biological component, which will show in detail the presence of the disease.

In parallel, the doctor may prescribe an ultrasound, x-ray, or CT scan of the kidneys. This is due to the fact that this type of disease is closely related to oncology.

Treatment of the disease

When such a serious illness occurs, treatment must be comprehensive. Getting rid of dermatitis herpetiformis (Dühring's disease) is quite difficult, so several methods are used at once.
“With a comprehensive solution to the problem, including diet and treatment at home, you will rarely be bothered by rashes on your body,” says dermatologist of the highest category E.A. Malyshevsky.
For drug treatment, doctors prescribe the sulfone group of drugs:

Sulfasalazine is an anti-inflammatory, antimicrobial agent prescribed by a doctor. It has contraindications, so be sure to read the instructions
Diucifon is a powder used to treat rashes on the body. Has contraindications
Dexamethasone is a corticosteroid if sulfone drugs do not help. Has antiallergic, antitoxic effect. There are many contraindications
Erius is an antihistamine that is prescribed to relieve itching

The areas affected by the disease must be constantly treated with a solution of potassium permanganate or brilliant green. Antihistamine ointments can be purchased.

It is mandatory to take vitamin complexes, because the body loses many useful substances after taking such medications.

Traditional treatment

If a person has dermatitis herpetiformis, all treatment options should be tried. Traditional medicine offers many recipes for getting rid of itching, pain and burning.
You can try brewing herbs such as violet, sea buckthorn, knotweed, calendula (anything that has an anti-inflammatory effect). Pour boiling water over them and let them sit for an hour. Take the infusion about two times a day before meals, a teaspoon.
Important! Remember, self-medication is life-threatening. Therefore, before trying folk remedies, you should consult your doctor.
Vodka infusion can be used externally. You need to take nettle, yarrow, juniper, pour vodka over them, leave for a week. Then wipe the affected areas.
You can prepare ointments from pork fat and herbs. Make compresses from such ointments.
Tea with honey and lemon balm is perfect. You can drink it every morning. The herb has an anti-inflammatory, calming and restorative effect.
A herb such as St. John's wort will also help well with this disease. Old people are often saved by it. You can make ointments, oils, and baths from it. This herb will help get rid of itching and burning.

Proper nutrition

When the human body is affected by dermatitis herpetiformis, you must definitely think about a diet that will help you get rid of the disease faster.
It is strictly prohibited to eat:
Beans, cereals, flour, kvass, beer, sweets, products containing honey, cabbage.
Everything else is possible, so eating right with this disease is not difficult.
Be sure to include lean meat, broths, vegetables, and dairy products in your diet. Drinks include only natural black coffee and mineral water without iodine. Eat plenty of greens, olives, olives.

Prevention

This disease is considered chronic, so it is necessary to constantly take preventive measures.
They are extremely simple: exclude from your food all foods that contain iodine. And be sure to undergo examinations at the hospital.
Remember that all medications must be taken only as prescribed by your doctor.
If a person is overweight, it is necessary to go on a certain diet and reduce the amount of fat consumed.
Due to the fact that blisters sometimes appear in the mouth, food should be soft and not spicy, so as not to irritate the mucous membranes even more. It is advisable to rinse your mouth after every meal.
Taking a hot bath or visiting the sauna is strictly prohibited. The shower should not be hot; you should not rub the inflamed areas with a washcloth.
Walking in the fresh air, sunbathing, and good sleep are required.
This disease is chronic, but not contagious to others. Therefore, a person can calmly contact people.
This type of dermatitis is considered chronic and cannot be completely cured. But we must constantly carry out preventive measures, follow all the doctor’s recommendations, then it will be possible to avoid frequent recurrences. Treatment takes quite a long time and is difficult, so a complex of methods must be used. But never self-medicate, this can cause even more serious consequences, such as infection. Then there will be more foci of inflammation, and it will become much more difficult to get rid of them. Your body will weaken and your immunity will deteriorate. Therefore, it is best to strictly follow the recommendations of a qualified specialist. Be healthy!

Dühring's disease, or bullous dermatitis herpetiformis, is a dermatosis that is characterized by a primary polymorphic rash (true polymorphism), severe itching, burning sensation, paresthesia and a chronic course with periodic relapses and remissions.

Prevalence of the disease

The available data from various authors is ambiguous. The number of patients per 100 thousand population ranges from 11.3 to 75.5. Moreover, according to studies by some authors, men are somewhat more likely to get sick, while according to others, women are more likely to get sick. Dühring's dermatitis herpetiformis occurs mainly in Northern European countries among adults, predominantly middle-aged (30-40 years), and somewhat less frequently among older people. In children, this pathology is quite rare, but among them about 10% are infants.

Causes and mechanism of development of pathology

The disease has been known for more than 130 years, but its causes and pathogenesis have not yet been fully established. In 1966 and subsequent years, reports began to appear of celiac disease among many patients with dermatitis herpetiformis. Celiac disease, or gluten-sensitive enteropathy, is damage to the villi of the epithelium of the small intestine by the protein gluten or similar hordein, avenin, etc., contained in the gluten of cereal plants - barley, wheat, rye, oats. This intestinal pathology is often accompanied by symptoms of malabsorption.

Genetic theory

According to the results of family studies, 4-7% of patients with Dühring's disease had immediate relatives with the same disease and a significantly higher percentage with relatives suffering from celiac disease. In addition, monozygotic twins were identified, one of whom suffers from gluten-sensitive enteropathy, and the second from dermatitis herpetiformis.

All these and many other facts served as the basis for the assumption of the genetic nature and similarities between these two pathological conditions. Confirmation is the presence in 90% of such patients on the sixth chromosome of various forms of the same gene, which determine the variant of development of the disease (Dühring's dermatitis or celiac disease).

Autoimmune theory of the pathogenesis of dermatitis herpetiformis

When serological examination of affected areas of the skin using the direct immunofluorescence technique, in most patients fixed deposits of immunoglobulin “A” (IgA) are detected at the junction of the epidermis with the dermis or in the papillary layer of the skin. IgA is an antibody and is located in the form of granules in the area and within the dermal papillae, located near the basement membrane.

These antibodies are directed against the structural components of the dermal papillae. Some patients have gluten-IgA complexes that also circulate in the blood. According to various data, in 30-100% of patients with dermatitis herpetiformis without gastrointestinal symptoms in the mucous membrane of the small intestine, partial or complete atrophy of the villi of the epithelium of the small intestinal mucosa is found, similar to celiac disease.

In this regard, the most widespread is the autoimmune theory of the pathogenesis of the disease, according to which the mechanism of development of pathology lies in autoimmune tissue damage.

Provoking factors

Thus, it is assumed that the genetic cause of the disease is realized through an autoimmune mechanism in the presence of provoking factors - background diseases and disorders in the body. The main ones are:

Consumption of a relatively significant amount of flour products and dishes with pearl barley, semolina and barley, starch, which contain gluten and similar protein components, as well as hypersensitivity to iodine, iodine preparations and seafood (contain iodine). In this regard, the diet for Dühring's dermatitis is the basis of pathogenetic therapy.
Allergic reactions to vaccines and/or medications (less common).
Autoimmune connective tissue diseases.
Acute or chronic thyroiditis.
Diabetes mellitus type I.
Malignant tumors.
Blood diseases (lymphogranulomatosis).
Physiological changes in the endocrine system (during puberty, pregnancy, menopause).
Viral infections, helminthic infestations and intoxication of the body.
Exposure to ultraviolet rays and stress conditions.

Symptoms of Dühring's dermatitis

Character of the current

The disease begins gradually, can last for several weeks or even months and is accompanied by moderate itching and burning of the skin, which are precursors. Acquiring a chronic course, dermatitis herpetiformis is interrupted by periodic remissions, the duration of which ranges from 3 months to 1 year. Relapses can last for years.

The onset is manifested by a moderate increase in temperature and subjective sensations in the form of general malaise, decreased appetite, burning and tingling of the skin.

Description of the rash

Characteristic of skin rashes in this pathology is true polymorphism, caused by a combination of different primary (erythema, nodules, papules, blisters) elements with the further addition of false polymorphism in the form of a combination of secondary elements (erosions, crusts and excoriations). The appearance of a rash is always accompanied by a burning sensation and intense itching.

Erythematous spots have fairly clear rounded outlines and, as a rule, are small in size. If swelling develops, they rise somewhat above healthy skin, and the surface becomes smooth and deep pink-red.

Then, gradually, due to the “sweating” of the liquid part of the blood through the walls of the dilated vessels, a urticarial (nodular) rash is formed against the background of the spots. All this looks like hives.

Urticarial elements in Dühring's dermatitis tend to grow in a peripheral direction and merge with each other, resulting in the formation of large bluish-pink lesions with clear boundaries that have bizarre, scalloped or (less often) regular rounded outlines. The surface of the lesions is covered with individual bubbles (vesicles), serous and bloody crusts and excoriations (traces of scratching). The lesions themselves tend to merge with the formation of rings with a diameter of up to 20-30 mm, arcs, figures with bizarre outlines and garlands.

The vesicles are small in size (no more than 2-3 mm). They can appear both on spots and against the background of a visually healthy skin surface. The blisters are covered with a dense covering and contain serous fluid. If they are grouped, they resemble the rash of herpes simplex. As a result of their drying, a light crust is formed. But more often, their contents gradually become cloudy and as a result of the addition of a secondary infection (especially when scratching), a pustule with purulent contents forms.

After opening the vesicles, erosive surfaces are exposed that are not prone to fusion, which become covered with a bloody crust and quickly epithelialize. If rashes appear in the form of blisters (bulae), then they are characterized by the same clinical and evolutionary development as vesicles. Their difference lies only in their different sizes, reaching a diameter of 5-20 mm in the blisters. A large number of eosinophils are often found in the contents of vesicles and blisters from the first days or a little later.

The rashes are mainly symmetrical and localized on the scalp, on the skin of the face and back of the neck, on the arms and legs (extensor surface), in the area of the shoulder, elbow and knee joints, on the skin of the lumbosacral and buttock areas. Uncharacteristic of dermatitis herpetiformis is damage to the mucous membranes, but according to some authors it can be detected in 50% of patients. In exceptional cases, erythema, vesicles or bullae on the oral mucosa subsequently transform into erosions.

Depending on the predominance of the primary elements of the rash, the following main forms of dermatosis are conventionally distinguished:

papular;
urticoid;
vesicular;
pustular.

After the rash resolves, peeling and gradually disappearing areas of hyperpigmentation or depigmentation appear in its place.

Diagnostics

The diagnosis is made based on:

medical history data - the presence of close relatives with Dühring's dermatitis or celiac disease, the development of the disease or its exacerbation after taking gluten- or iodine-containing products or drugs;
the nature of the rash - true and false polymorphism, specific localization, symmetry, tendency to merge and group elements;
severe itching and burning that accompany the rash;
the presence of eosinophilia in the blood and/or fluid of the blisters; at the same time, its absence does not exclude pathology;
a positive Jadasson test, which consists of applying 50% potassium iodide ointment to the skin of the forearm in the form of a compress for 1 day;
histological examination data - the presence of blisters under the epidermis with significant accumulations of eosinophils and neutrophils at the apex of the dermal papillae, dilated dermal blood vessels; the latter are surrounded by infiltrates consisting of accumulations of eosinophils and fragments of destroyed nuclei (“nuclear dust”) with neutrophilic leukocytes;
detection of IgA in the basement membrane area (during a direct immunofluorescent reaction).

Features of the clinical course in children

In most children, Dühring's dermatitis develops after an infectious disease. The onset of the disease, as a rule, is acute, with a temperature rising to 39° within a week and severe symptoms of general intoxication - lethargy or, conversely, agitation, lethargy and lack of appetite.

On the head, neck, torso (back, anterior surface of the chest, abdominal area, buttocks), on the skin of the extremities (with the exception of the palmar and plantar surfaces), edematous foci appear symmetrically, against which other types of rash quickly appear. Especially often, rashes are localized in the area of the external genitalia and in large skin folds.

Bullous dermatitis herpetiformis is characterized by larger elements than in adults, more frequent suppuration and localization on the mucous membranes of the oral cavity, as well as a rarer content of an increased number of eosinophils in the contents of the blisters. In children, there is a predominance of common forms of localization of the rash with the development of polyadenitis (enlargement of multiple lymph nodes), but a lesser tendency to grouping and merging of elements. How to treat the disease?

Treatment of Dühring's dermatitis herpetiformis

A comprehensive treatment method includes the recommendation of a diet that includes restriction or exclusion (during periods of relapse) of the above-mentioned foods, as well as cabbage, legumes, beans, bread kvass, beer, table salt, seafood, sausages, chocolate, ice cream. Recommended dishes using rice, buckwheat, corn, consumption of increased amounts of fruit, drinks - black and green tea, natural coffee, mineral water low in iodine and bromine.

Treatment of Dühring's dermatitis with folk remedies includes mainly external remedies that help reduce itching and inflammatory processes - baths with infusion of St. John's wort, flowers and leaves of periwinkle, knotweed herb, calendula, tricolor violet, with a decoction of licorice root, etc. Infusions are recommended for treating the skin in affected areas , oils and ointments containing extracts of the same plants.

Of the drugs, the most effective are drugs of the sulfone series (dapsone, diaphenylsulfone, DDS, avlosulfone, sulfapyridine, diucifon, etc.) according to a certain regimen as drug monotherapy. In cases of prolonged or severe course, they are combined with glucocorticosteroids.

Duhring's is a chronic skin disease with periodic relapses, the symptoms of which cause significant discomfort in patients - both physical and psychological. Treatment is carried out according to proven methods; prevention does not require significant effort, but only if the patient is sufficiently informed about his condition.

Description of Dühring's dermatitis herpetiformis

Dühring's dermatitis herpetiformis is a pathological condition first described by dermatology professor Louis A. Dühring in 1884. The typical symptoms of the disease, named by its discoverer as Dermatitis dolorosa, or painful dermatitis, were finally characterized by Louis Brock four years later.

Duhring's dermatitis herpetiformis is also known as Duhring's disease, Duhring's dermatosis, Broca's polymorphic dermatitis, Duhring-Broca's dermatitis, Fox's pruritic hydra, Fox-Crocker's hydra herpetiformis, Kaposi's pruriginous pemphigus.

The clinical picture, manifested in the form of rashes, blisters, spots on the skin, is very similar to a herpes infection.

Based on this similarity, dermatitis herpetiformis received its modern name.

Forms of the disease Visual examination of the skin rash plays a significant role in the diagnosis of Dühring's dermatitis.

Depending on the prevailing type of rash (vesicles, papules, blisters), the so-called typical forms of the disease are described:
vesicular - the rash consists of bubbles (vesicles) slightly protruding above the surface of the skin;
papular - there are multiple nodules (papules) without voids;
bullous - multiple blisters (bullas) are formed, abundantly filled with fluid;

If the formations merge with each other, transform, or undergo erosion, the clinical picture may demonstrate atypical forms of dermatitis. Among these, the most common are:

vegetative - branched foci of villous shape are formed;
localized - symptoms are expressed in a limited area of skin;
pemphigoid - the blisters are thicker than usual and break with great difficulty;
strophuloid - miniature bubbles appear at the tops of the nodules;
trichophytoid - the rash has wavy edges and is prone to peeling, which strongly resembles a fungal infection;
eczematoid - the lesions are covered with numerous blisters and nodules that quickly form wet erosions.

A separate category includes the so-called senile dermatitis, mainly caused by age-related changes in metabolism, inhibition of liver function, decreased blood flow activity in the skin, and also, with some probability, serving as a sign of a neoplastic process in the body. This type is characterized by a changing rash of different sizes, forming an atypical form of the disease.

Causes and development factors

Among all dermatoses, the frequency of manifestations of Dühring's dermatitis is relatively low, amounting to approximately 0.2–0.48% of the total number of cases. Depending on the place of residence, dietary habits, origin, and many other factors, this indicator can fluctuate significantly. Thus, it has been proven that the descendants of the indigenous population of Northern Europe and Northern India, who have genes for hypersensitivity to gluten, are much more likely to develop dermatitis herpetiformis than the rest of the population of the planet.

Men aged 20 to 40 years are most susceptible to the disease. Women suffer from Dühring's dermatitis much less frequently. In children and the elderly, in addition to lower incidence, differences in the causes of dermatitis are noted, as well as the severity of symptoms.

The etiology of Dühring's disease remains unclear to this day. One of the first hypotheses seeking to explain the occurrence of dermatitis herpetiformis was infectious, which was later criticized. Viral, neurogenic and endocrine hypotheses are also debatable.

From the point of view of modern science, the most consistent version seems to be about an autoimmune origin, formed in the mid-60s of the twentieth century. The allergic hypothesis also has significant weight.

The autoimmune origin of Dühring's dermatitis is confirmed by changes in the small intestinal mucosa observed in patients. Histological studies demonstrate atrophy of intestinal villi of varying degrees, as a result of which malabsorption phenomena are frequent - difficulties in the absorption of nutrients and electrolytes. Sensitivity to gluten, a protein found in cereal plants, appears. The concentration of immunoglobulin A in the blood serum increases, the level of other immunoglobulins fluctuates significantly. Under the basement membrane of the intestinal epithelium, there is an active accumulation of autoantibodies to IgA. Changes in the tissues of the small intestine resemble the clinical picture of celiac enteropathy and celiac disease, as a result of which leading researchers raise the question, if not about the identity of these diseases, then about their common origin.

The allergic hypothesis is based on an increase in the blood level of eosinophils - cells involved in anti-allergic reactions. Also noteworthy is the decrease in the blood’s ability to inactivate histamine (the so-called histaminopexic index), the body’s acute sensitivity to bromine and iodine.

In some cases, Dühring's dermatitis acts as a para-oncological condition accompanying the development of a malignant tumor. Particular attention is required if the disease develops in old age.

Comparative table of hypotheses for the occurrence of the disease

Hypothesis	The essence	Criticism of the hypothesis
Autoimmune	Dermatitis occurs due to structural damage in the body caused by an attack by the body's own immune system.	The most confirmed hypotheses are often complementary.
Allergic	Dermatitis occurs due to foreign substances entering the body (iodine, bromine, organic toxins).	The most confirmed hypotheses are often complementary.
Viral	Dermatitis is caused by exposure to the herpes virus.	The disease is sensitive to antiviral drugs only in rare cases; the diagnostic picture does not correspond to a herpetic infection.
Infectious	Dermatitis occurs due to the proliferation of certain microorganisms on the surface of the skin.	Microorganisms are more likely to be a concomitant infection than a cause of the disease.
Neurogenic	Dermatitis occurs as a reaction of the body to disturbances in the functioning of the central nervous system, during exhaustion, and stress.	Special cases, often explained by autoimmune and allergic disorders.
Endocrine	Dermatitis is caused by disruption of the endocrine glands.

Symptoms and signs

Dermatitis herpetiformis is characterized by an acute onset, which is often preceded by general weakness and a slight increase in body temperature. An itching and tingling sensation occurs on the surface of the skin, then the affected areas become covered with scarlet or bright red rashes. The most common places where the rash is localized are the bends of the knees and elbows, shoulders, shoulder blades, lower back, and buttocks. Occasionally, rashes are observed in the oral cavity, on the scalp, face, and neck. A typical sign of Dühring's disease is the absence of a rash on the soles and palms, although in the latter case large patches of subcutaneous hemorrhage may form.

Over time, polymorphic and false polymorphic rashes form against the background of an edematous rash. Initially, round erythematous spots with a diameter of 0.2–0.5 cm are covered with serous crusts, scratches, filled with fluid from nearby vessels, transforming either into compacted papules or into blistering-like urticarial formations. Elements of the rash can also take the form of small vesicular rashes, or develop into large, over 2 cm, bullous formations.

With further development of the disease, the rashes merge, change shape, form various nodules and blisters, and collapse.

Diagnostics

The abrasions resulting from scratching become infected. The color of the rash changes to bluish-pink, and erosions appear under the opened blisters. After healing, areas with heterogeneous pigmentation are observed on the surface of the skin; particularly severe cases of the disease lead to the formation of deep scars.

The Jadasson test is used as a rapid test that can detect dermatitis herpetiformis, but is not strictly specific. This method involves applying a compress with 50% potassium iodide ointment to the skin of the person being tested. If the reaction is positive, contact for 24 hours leads to the development of redness and polymorphic rashes.

The main diagnostic value is histological examination of the affected integument, which makes it possible to differentiate Dühring's dermatitis from true and non-acantholic pemphigus, subcorneal pustular dermatosis of Sneddon-Wilkinson, and toxicoderma. A typical picture of the pathology is cavities under the upper layer of skin, accumulation of fluid containing numerous living and dead eosinophils, and a decrease in the number of collagen fibers.

Carrying out an immunochemical blood test makes it possible to differentiate Dühring's disease from skin manifestations caused by herpes virus types 1 and 2. The analysis indicates the presence of immunoglobulins A specific to tissue transglutaminase, which indicates an autoimmune process, but there are no antibodies of classes G and M characteristic of herpes infection.

Treatment

Treatment of the disease involves an integrated approach - a combination of medications, lifestyle changes and physical therapy.

Local preparations

Local treatment of affected areas of the skin is carried out using warm baths containing potassium permanganate, followed by treatment with 1–2% solutions of aniline dyes and fucorcin. Anti-inflammatory ointments and sprays containing 2–5% naphthalan, dermatol, ichthyol, as well as corticosteroid drugs are highly effective.

General drug therapy

For general treatment, antihistamines (Zyrtec, Claritin, Loratadine, Suprastin, Cetirizine, Erius) and corticosteroids (Prednisolone, Dexamethasone) are used to relieve painful symptoms. Drugs of the sulfone group (Dapsone, Diucifon) are used in combination with corticosteroids. Their use involves short courses of administration (5–6 days) with breaks of 1–3 days. It should be borne in mind that sulfones can change the state of the blood; their use requires regular biochemical tests.

In particularly severe cases of the disease, the use of detoxification drugs (Unitiol), blood and plasma transfusions is provided. Gamma globulin courses are effective in the amount of 5-6 injections of 1.5 ml, administered twice a week.

To improve the general condition of the body, it is recommended to take vitamins (A, B1, B2, B3, B6, B12, C, PP), preferably as part of vitamin complexes.

Physiotherapy

The first known physiotherapeutic method that could improve the condition of a patient with dermatitis was hydrotherapy. The use of baths and hot springs shows high efficiency to this day.

There is an assumption that one of the leaders of the French Revolution, Jean-Paul Marat, suffered from a severe form of Dühring's disease. The only thing that brought him relief was warm baths with herbal mixtures, in which the revolutionary not only rested, but also wrote his works.

It is beneficial for the patient’s general condition to stay in areas with an improved climate (mountain, coniferous forest). Vacations near the sea should be treated with caution, since natural iodine contained in the environment can provoke an allergic reaction.

Effective for local treatment:

electrophoresis and phonophoresis with anti-inflammatory ointments;
ultraviolet irradiation, which reduces pain and promotes rapid healing;
laser therapy of the red and infrared spectrum, accelerating skin restoration;

Traditional treatment

Folk remedies, given the activity of some herbal components, must be used in combination with drug treatment, and only after consultation with a dermatologist.

For external use, an ointment containing 1 part belladonna herb and 2 parts rendered internal fat is used. The mixture is ready for use after prolonged simmering at +90℃ and filtering; it should be lubricated daily on the affected skin. To wipe the rash, a herbal mixture infused in a liter of vodka, consisting of 2 tbsp. l. herbs calendula, nettle, juniper, tansy and yarrow. The tincture must be kept in the dark for 10 days.

For oral administration, water infusions of calendula herbs, knotweed, violet, juniper berries, sea buckthorn, and licorice root are recommended. They can be brewed separately (1 tablespoon per liter of boiling water), or as part of a mixture. It is recommended to take 1 tbsp. l. twice a day, half an hour before meals.

Before using any folk remedies, you should consult your doctor, especially if you have concomitant diseases.

In order to increase the overall tone of the body, it is possible to take strengthening agents - tinctures of aralia, ginseng, eleutherococcus, echinacea. It should be remembered that the use of such drugs also increases the load on the cardiovascular system.

Nutrition Features

At the first manifestations of vesicular dermatitis herpetiformis, it is recommended to change the diet. Any products containing gluten, that is, those made from grains of oats, wheat, rye, soy, or barley, are prohibited. You should be wary of low-quality sausages, which often contain vegetable protein. It is not recommended to consume iodine-containing products (kelp, sea fish, shellfish), which can cause an allergic reaction.

The deficiency of fiber in the diet should be compensated by eating green salads, vegetables, fruits, and nuts. Lean red meat, chicken, and fermented milk products are very healthy. To prepare homemade baked goods, you need to use thermophilic yeast and gluten-free flour.

Foods you should avoid, pictured

Sweet chocolate often contains traces of gluten Gluten is added to minced meats Wheat, rye, oats, barley are not healthy for everyone In factory production, gluten is used as a stabilizer. The amount of grain fillers in crab sticks often exceeds reasonable doses Children suffering from Dühring's dermatitis require careful selection of nutrition Some alcohols retain significant amounts of gluten
Wheat contains 10–15% gluten by weight Seaweed contains large amounts of allergenic iodine Like many other seafood, shellfish accumulate significant amounts of iodine

Selection of products for a gluten-free diet - video

Treatment prognosis and possible consequences

The prognosis is favorable with a timely diagnosis, properly selected treatment and following a diet. Comprehensive measures not only relieve symptoms, but also reduce the risk of relapse in the future. Dermatitis herpetiformis itself does not cause serious complications. The marks left on the skin after the polymorphic rash has healed are more of a cosmetic defect.

On the other hand, Dühring's disease is often a manifestation of hidden processes occurring in the body - autoimmune, neoplastic, hormonal. Ignoring these problems can further lead to the development of much more serious diseases: vitiligo, lupus, alopecia areata, sarcoidosis, Sjogren's syndrome. Disturbances in blood biochemistry can initiate problems with the thyroid gland. Damaged small intestinal epithelium becomes vulnerable to intestinal lymphoma.

Prevention

The first and most effective method of prevention is changing your diet.. If there is a hereditary predisposition to autoimmune diseases, gluten intolerance, or the first symptoms of Dühring's disease appear, it is recommended to switch to a gluten-free diet, exclude iodine-containing foods from the diet, and also pay special attention to a sufficient intake of vitamins.

Features of the disease in children

Children suffer from dermatitis herpetiformis much less frequently than adults, but the course of the disease often occurs in a more acute form. The disease mainly manifests itself in the cold season. The primary symptoms are:

smooth increase in temperature to 39℃;
joint pain;
lack of appetite;
dyspepsia;
lethargy, or, on the contrary, excessive excitement.

Itching and rash can be located on any part of the body except the palms and soles. In most cases, lesions merge into irregular shapes: rings, arcs, garlands, shapeless elements. Large, cherry-sized blisters filled with dark contents form on the skin of infants. Collapsed blisters easily form deep, weeping erosions.

A blood test indicates increased eosinophilia, leukocytosis, increased levels of lipids and abnormal immunoglobulins, and decreased albumin concentrations. Complications in the form of pyococcal infection are common, and the lymph nodes are enlarged in most cases.

Despite the severe course of the disease, accompanied by frequent relapses, children suffer from dermatitis herpetiformis with fewer negative consequences than adults. Relapses usually subside during puberty.

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 rashes with herpes. Diagnosis is carried out using histological examination, analysis of the contents of blisters and direct immunofluorescence reaction. The sulfone group of drugs and corticosteroids are effective in the treatment of Dühring's dermatitis herpetiformis.

General information

Dühring's dermatitis herpetiformis occurs at any age, but most often it develops at 30-40 years of age. Men are more susceptible to this disease than women. In some cases, Dühring'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

The causes and mechanism of development of Dühring's dermatitis herpetiformis are unknown. Many patients have an intolerance to the protein gluten contained in cereal plants. The autoimmune component in the development of the disease is supported by the detection of IgA antibodies at the border of the dermis and epidermis - in the area of the basement membrane. It is believed that increased iodine sensitivity, heredity, ascariasis, inflammatory processes of the gastrointestinal tract (gastritis, peptic ulcer), viral diseases (ARVI, herpetic infection, etc.) play a certain role in the occurrence of Dühring's dermatitis herpetiformis.

Symptoms

Typically, Dühring's dermatitis herpetiformis has an acute onset with the appearance of foci of a polymorphic rash. The rash may be preceded by a moderate rise in body temperature, general weakness, itching and a tingling feeling. Elements of the rash can appear on any part of the skin, except 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. Petechiae and ecchymoses may appear on the palms - large (more than 3 mm) spots of intradermal hemorrhages. The rash is accompanied by severe discomfort: a burning sensation, intense itching and paresthesia. Damage to the mucous membranes in Dühring's dermatitis herpetiformis is usually absent. In rare cases, blisters may appear in the oral cavity, quickly turning into erosions.

True polymorphism of the rash in Dühring's dermatitis herpetiformis is associated with the simultaneous appearance of erythematous spots, blisters, papules and blisters on the skin of various sizes. Over time, false polymorphism is added to true polymorphism: erosions and crusts are formed associated with the transformation of rashes, as well as excoriations caused by strong scratching of the skin. When the elements of the rash heal, areas of hypo- and hyperpigmentation, and sometimes scars, remain on the skin.

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

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

Depending on the predominance of one or another type of rash over the others, the following types of Dühring's dermatitis herpetiformis are distinguished: papular, vesicular, bullous and urticariform. Atypical variants of the disease are possible: trichophytoid, eczematoid, strophuloid, etc.

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

Diagnostics

If Dühring's dermatitis herpetiformis is suspected, a Jadassohn iodine test is performed. A compress with an ointment containing 50% potassium iodide is applied to a healthy area of skin. After 24 hours, the compress is removed. The detection of redness, vesicles or papules in its place speaks in favor of Dühring's dermatitis herpetiformis. If the test is negative, then it is repeated. To do this, after 48 hours, apply the same compress to the area of pigmentation remaining after the former rash. The Jadassohn test can be performed with iodine taken orally. But such a study is fraught with a sharp exacerbation of the disease.

In Dühring's dermatitis herpetiformis, a clinical blood test reveals an increased content of eosinophils. Cytological examination of the contents of the blisters also reveals a large number of eosinophils. However, these data, like the Jadassohn test, are not mandatory or strictly specific for the disease.

The most reliable way to diagnose Dühring's dermatitis herpetiformis is considered to be histological examination of areas of affected skin. It reveals cavities located under the epidermis, accumulations of eosinophils, neutrophils and the remains of their destroyed nuclei. The direct immunofluorescence reaction (RIF) detects IgA deposits at the apices of the dermal papillae. dermatologist. A diet is prescribed that excludes grains and iodine-containing foods (sea fish, seafood, salad, etc.). Drug therapy is carried out with drugs of the sulfone group: diaphenylsulfone, sulfasalazine, solusulfone and others. These drugs are usually prescribed orally 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 Dühring's dermatitis herpetiformis includes warm baths with a solution of potassium permanganate, opening the blisters and treating them with brilliant green or fucarcin, applying corticosteroid ointments or aerosols, and using 5% dermatol ointment.

Dühring's disease is a type of skin disease. To date, doctors have not been able to accurately establish the cause that provokes the development of this disease.

The main feature of Dühring's disease is that it has a long course, during which a rash appears on the surface of the skin in the form of bubbles and blisters, which are grouped into rings or garlands. This rash can be quite painful and will cause an unpleasant feeling of discomfort, accompanied by severe itching and burning.

Most often, people aged between 15 and 60 years suffer from Dühring's disease, with the peak of the disease occurring between the ages of 30 and 40 years. Unlike women, men suffer significantly more often

Symptoms

Most often, this disease manifests itself with a slight increase in temperature and a feeling of weakness throughout the body. In the affected area, a slight tingling of the skin is felt and severe itching develops, accompanied by a burning sensation. Literally after a few days, a rash appears on the surface of the skin, which in appearance strongly resembles herpes.

Most often, such a rash begins to appear on the flexor parts of the body - for example, on the elbow, shoulder, legs, buttocks or lower back. In this case, the rash will never appear on the surface of the foot or palms. However, subcutaneous hemorrhages called petechiae may appear on the palms. In the rarest cases, a rash forms on the mucous membranes of the mouth, but this possibility should not be ruled out.

In the presence of Dühring's dermatitis, a varied (polymorphic) rash may appear, which forms in the form of red spots covered with a painful crust and causing severe itching or papules, and the formation of transparent blisters is also possible.

Inside the blisters there is clear or slightly cloudy content, which may contain a slight admixture of blood. Literally after 3 or 4 days, the bubbles can open, after which red erosion begins to form in their place. After healing, scars or hyperpigmented areas appear at the site of erosion.

Quite often, this disease is accompanied by such an unpleasant symptom as profuse, fatty stools, which may have an unpleasant grayish tint. That is why, if your health worsens or the first signs of Dühring’s disease appear, you need to seek help from an experienced doctor who, after examining the patient, will prescribe treatment.

In the future, Dühring's disease will be chronic, that is, constantly accompanied by recurrent attacks that manifest themselves throughout life. The period of remission will be quite short, during which dermatitis can progress to a torpid stage. In this case, the general condition of the patient is disrupted - immunity is significantly reduced, as a result of which there is a risk of developing various secondary diseases, which significantly complicate treatment.

Diagnostics

If there is a suspicion of Dühring's dermatitis herpetiformis, the doctor may perform a Jadassohn iodine test. When carrying out such an analysis, a special compress is applied to the affected area of the skin, in which an ointment containing 50% potassium iodine is used. This compress must be worn for 24 hours, after which it is removed. If redness remains on the skin, it means you have Dühring's disease.

But there are cases when the result is negative, then a repeat test may be prescribed. In this case, a second compress is applied to the area of pigmentation that remains after the rash, but not earlier than after 48 hours. It is worth considering that such an analysis may result in a sharp exacerbation of the disease.

When diagnosing Dühring's dermatitis, the entire clinical picture of the course of the disease must be taken into account - these are subepidermal vesicles that have a swollen, hyperemic base and can be accompanied by quite severe itching and an unpleasant burning sensation. Not only in the contents of these blisters, but also in the blood, pronounced eosinophilia is observed. The patient begins to show increased sensitivity to iodine.

Modern laboratory techniques can also be used to diagnose this disease. In the presence of Dühring's dermatitis, subepidermally located blisters appear, which in some cases may also be intraepidermal. If there is an accumulation of fibrin bubbles in the internal contents and the presence of eosinophilic granulocytes, there is a risk of developing microabscesses.

Prevention

It is worth remembering that Dühring's disease is one of the chronic diseases that can be accompanied by relapses throughout a person's life. However, despite this, for most patients there is a very favorable prognosis if you adhere to a few fairly simple recommendations for the prevention of this disease.

To prevent the possible development of a relapse, you need to pay special attention to your own diet. It is worth completely eliminating from your diet products made from wheat, barley, oats, rye, and of course, you should give up those products that include iodine - for example, sea fish, seaweed and much more. People suffering from Dühring's disease are strictly prohibited from using any medications that contain iodine.

This disease can last for several years, periodically interrupted by short periods of stable remissions, the duration of which can range from several weeks to months. There are cases when children who have entered puberty experience a complete recovery.

As already written above, it is necessary to strictly follow a simple diet, in which all products containing iodine are completely excluded.

Patients should be constantly monitored by a dermatologist and undergo periodic examinations, during which there is a risk of detecting the presence of cancer.

Treatment

It is worth preparing for the fact that the treatment of Dühring's disease will take quite a long time. Before the doctor prescribes a course of treatment, the patient will have to undergo examination for the presence of diseases of the gastrointestinal tract, as well as oncological pathologies.

The most effective treatment methods are those that use derivatives of the sulfone series - these are diucifon, and diaphenylsulfone, as well as others. The drugs should be used in cycles of 5 days, during which short breaks of 1 or 2 days are taken (this is determined only by the attending physician).

During treatment, it is necessary to closely monitor blood and urine tests, as there is a risk of side effects, which may include nausea, severe vomiting, aranulocytosis, and others. Complex treatment should include the use of antioxidants, as well as unithiol.

Discussion and reviews (3)

Larisa

When my son was 10 years old, he developed Duhring's disease. Then we lived in Crimea. No matter how many doctors we went to, no one could help us. Even doctors could not make a diagnosis. They neglected it to such an extent that we could have lost the child. He had a high fever and the blisters on his legs were bursting. And they all sprinkled us with some kind of red milk. And then my husband’s brother told us that we should urgently take him to Moscow. There he was admitted to a clinic, I don’t remember which one now. They immediately made a diagnosis, made some kind of white ointment, smeared it from head to toe, we stayed there for a month and things began to recover. Now my son is 46 years old. After that incident, this did not happen again. God bless! And when we returned from Moscow, our doctors were surprised. In the provinces, doctors don’t know much.