dermatologic disorders
Dermatitis Herpetiformis
Treatment of Dermatitis Herpetiformis
Dapsone Gluten-free diet Dapsonegenerally results in remarkable improvement. Initial dosages ofdapsoneare 25 to 50 mg orally once a day in adults and 0.5 mg/kg in children. Usually, this dose dramatically relieves dermatitis herpetiformis symptoms, including itching and burning, within 1 to 3 days. If improvement occurs, the dose is continued. If no improvement occurs, the dose can be increased every week, up to 300 mg/day. Most patients respond well to 50 to 150 mg/day. can cause hemolytic anemia; risk is highest after 1 month of treatment and is increased in patients who have Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency . Patients suspected of having G6PD deficiency should be tested for this deficiency before being treated with Sulfapyridine 500 mg orally 3 times a day (or, alternatively,sulfasalazine) is an alternative for patients who cannot toleratedapsone. Doses of sulfapyridine up to 2000 mg orally 3 times a day can be used. Sulfapyridine may cause agranulocytosis. Patients receivingdapsoneor sulfapyridine should have a baseline complete blood count (CBC). CBC is then done weekly for 4 weeks, then every 2 to 3 weeks for 8 weeks, and every 12 to 16 weeks thereafter. Patients are also placed on a strict gluten-free diet. After initial therapy and disease stabilization, most patients can stop drug therapy and be maintained on the gluten-free diet, but this may take months or years. A gluten-free diet also maximizes improvement in the enteropathy and, if strictly followed for 5 to 10 years, decreases risk of small-bowel lymphoma. 