Suggest treatment for Dermatitis Herpetiformis

Posted on Sat, 14 Jun 2014 in Skin Hair and Nails
Question: I have been diagnosed with Dermatitis Herpetiformis . I am on day six of a starter dose of Dapsone 100mg oer day. I can see no improvement yet and the itching is worse than ever. Is thus usual?
Answered by Dr. Sanjay Kumar Kanodia 18 minutes later
Brief Answer:
Kindly add detail and pictures

Detailed Answer:

Welcome and hanks for posting your query to the forum.

I can understand your concern for Dermatitis Herpetiformis and no improvement after starting tablet dapsone.

Before I can directly answer your concern I humbly request to add certain important points regarding your skin condition:

-Since how long you have the skin problem. Can you elaborate your condition that whether you felt any vesicles or blisters or any itching over the same with main areas of distribution of these skin lesions.

- The diagnosis of Dermatitis Herpetiformis was given by a dermatologist after skin biopsy( sample of skin tissue processed and analyzed by microscope) or on clinical observation only.

- What treatment you were/are taking other than dapsone for the same.

It would be better if you can upload some good resolution pictures of the affected area. You can upload the pictures by utilizing our service. For that you have a feature to upload images by yourself at the right side of the query page. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia.

Hope to hear soon from your side.


Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sanjay Kumar Kanodia 9 minutes later
I have been seeing a consultant dermatologist. I have had two biopsies, a series of blood tests and a course of steroids which did not work . The DR gave me the diagnosis last week and started me on the Dapsone as set out in my original question.i am at my whits end with the itching and just want to know if it is going to get better soon
Answered by Dr. Sanjay Kumar Kanodia 6 hours later
Brief Answer:
Dapsone dose increment or combination therapy

Detailed Answer:

Welcome again to the forum and thanks for adding further informations to the query.

First of all I beg your pardon to take some time to reply the follow up. After analyzing the query with complete diligence I can make out that the diagnosis is confirmed by biopsy. So the diagnosis of Dermatitis Herpetiformis (DH) is clear.

Now at this stage let me guide you certain important things related to your condition:

In my patients with DH, once the diagnosis is confirmed I also start with dapsone. But in my clinical set up I preferably go for a baseline blood tests before starting the dapsone to rule out any abnormality or contraindication to the drug.

If the blood test are normal then I generally start with 50 mg for 1 week and then 100 mg for next 3 weeks to see the improvement. The low dose is given to check for any side effects as done by weekly blood tests for one month.

In my clinical experience most of the patients give history of improvement in itching in 3-4 days and gradual subsidence of lesions in nest few weeks. So the clinical improvement is seen within week period.

But in few percentage of cases an improvement is not seen with 100 mg of dose and therefore a gradual increase in dose is to be done. In these case I generally go up to 200-300mg per day with all blood tests reports in my hand. I also guide my patients that if at any time they see any bluish appearance of lips or nails or any type lethargic feeling then must report to me immediately. A clinical improvement is seen in most of these cases with gradual increase in dose and then the dose is tapered off accordingly.

In very few percentage of cases patients do not respond to even increase in dose too. In these cases I check for aggravating factors such as most importantly the diet. In all cases of DH diet pays an important role as one of the aggravating factor. In all cases of DH we prefer to give gluten free diet. So there should be avoidance of diet that contains gluten such as in wheat barley, rye and related cereals. I also ask my patients to have simple hoe made diet and no out side food or drinks of any type.

Even if by the avoidance of gluten free diet and dapsone the disease is not controlled then I generally combine dapsone with oral steroids in proper doses according to clinical severity. In all the cases who are poor responders to dapsone show good improvement in combination therapy in appropriate doses.

An antihistamine coverage round the clock is must to avoid the tendency to scratch. It also one of the very important factor in reducing the new eruption of lesions. In some cases I have to prescribe up to 3-4 times of antihistamine tablets.

So by reading all the above points you probably got some idea regarding the plan of management for Dermatitis Herpetiformis cases.

It is one of the simple clinical entity and proper dose titration with combination therapy works well in all the cases of DH. I suggest you to talk to your treating dermatologist regarding less improvement as 1 week of period show fair improvement in DH symptoms.

I hope these information will help you. I will be glad to answer any further of your queries.

Wish you good health.

Dr Sanjay Kumar Kanodia
(MD- Dermatology )
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Sanjay Kumar Kanodia


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