Treatment
Dermatitis herpetiformis responds well to medication and changes in diet.
Dapsone is an effective treatment for most patients. DH responds to dapsone so quickly (itching is significantly reduced within 2–3 days) that this response may almost be considered diagnostic. However, dapsone treatment has no effect on any intestinal damage (see coeliac disease) that might be present.
Therefore, a strict gluten-free diet must also be followed, and this will usually be a lifelong requirement. This will reduce any associated intestinal damage and the risk of other complications. After some time on a gluten-free diet, the dosage of dapsone can usually be reduced or even stopped, although this can take many years.
Dapsone is an antibacterial, and its role in the treatment of DH, which is not caused by bacteria, is poorly understood. It can cause adverse effects on the blood, so regular blood monitoring is required.
Dapsone is the drug of choice, but, for patients unable to tolerate dapsone for any reason, the following can be tried, although they are less effective:
- colchicine
- lymecycline
- nicotinamide
- tetracycline
- sulfamethoxypyridazine
- sulfapyridine
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