DERMATITIS HERPETIFORMIS

By : Jusnita Jayus 110202102 Triasnida 1102090014

Advisor : dr. Junia Kirana Heri Supervisor : Dr.dr. Sri Vitayani Muchtar, Sp.KK

INTRODUCTION
Dermatitis herpetiformis (DH) is also called Duhring Disease was first discovered by Louis Duhring (1884). He described that the DH is a chronic disease characterized by itching and skin lesions are often pleomorphic

Epidemiology
Dermatitis herpetiformis is often found in people in North America, and is very rarely found in the offspring of Asia and Africa. Dermatitis herpetiformis can found in all ages, usually attacking the average age about 40 years. Men> women, but in children girl is more

Etiology
Etiology of Dermatitis herpetiformis is unknown with certainty, but gluten, a protein found in wheat, barley, and rye, is believed to be the main cause of DH.

Pathogenesis
Intake gluten digested in the small intestine

Circulating in the blood

Arrested by IgA in the papillary dermis

Neutrofil activation

Clinical manifestation of DH

Clinical Features
- Extremely itchy or like a burning - primerly lesions on the DH is erythematous papules, plaques similar to urticaria, and vesicles. - Vesicles, particularly those in the palm of the hand can be hemoragic. - Lesions that had healed may be hyperpigmentation or hypopigmentation.

Distribution of the lesion

sumber : Pitzpatricks dermatology in general medicine

sumber : pitzpatricks dermatology in general medicine

Support examination
1. Histopatology

Neutrophillic microabscess within a dermal papilla

2. serology Examination of specific serologic antibody that appears Ig-A antiendomisium (EMA), which binds to the substance of smooth muscle (endomisium). 3. Immunofluorosence Direct immunofluorescence (DIF) obtained granular IgA deposits in the papillary dermis, and IgA appeared in large numbers in the near active lesions

Differential Diagnosis
Pemphigoid vulgaris - not itchy - Bulla walled slack easily broken

 Bullous pemphigoid

- There is a large subepidermal bulla and walled tense.

 Chronic bullous diseases of Childhood - There is a walled tense bulla on normal skin or erythema

Treatment
1. 2. 3. 4. 5. Dapsone 100 150 mg/day Sulfapiridin 1-4 mg/day Kortikosteroid Anti histamin Dietary gluten-free

Prognosis
Most people will experience chronic and residif DH.