PRESENTED by :

Muhammad Farfidia Hatala 110206026

Lina Mursalinda Saad
110205079

ADVISOR
dr. Rachma Olfiyanti Maksud
SUPERVISOR
dr. Andi Sastri Zainuddin, SpKK

Dermatitis Herpetiformis is a rare, intensely pruritic,

chronic, recurrent, papulovesicular disease.
The eruption is symmetrical and pleomorphic,
consisting of erythematous, urticarial, papular, vesicular
or bullous.
In 1884 Louis Duhring first described and that is called
Duhring disease, Duhring brocq disease

Dermatitis is most common in people of northern

Europan origin. Exceedingly in African-American and
Asians.
Onset : 4th Decade (2-90 years old)
Ratio : men : woman = 4 : 1
In 1985, Indonesia actually on center of dermatologic in
RSCM resulted 5 cases and 1986 resulted 7 cases.
Insidens : men : woman = 3: 2

The Etiology of Dermatitis Herpetiformis is unknown

yet.
Autoimmune disease, but that is very strong association
with HLA-B8 and others alloantigen. Also Deposit IgA
and GSE(Gluten Sensitive Enteropathy).

Unknown yet, but DH associated in most instance with

a subclinical GSE and deposition of IgA in the upper
dermis.
Granular IgA deposition within the dermal papillae is
the hallmark of DH

The primary lesion of Dermatitis Herpetiformis are :

An erythematous papule intensely pruritic
An urticarial-like plaque
Group of vesicle and large bullae
Patients may present with crusted lesions only.
The usual symmetric distribution of lesion on Elbows,
Knees, Buttocks, Shoulders and Sacral.

On Elbow

On Elbows and
Knees

On Buttocks

On Shoulders

The initial changes are first happened at the tips of the

dermal papillae, where edema an eosinophilic and
neutrophilic exudate occur to produce a subepidermal
separation.

In typical cases the diagnosis of DH can be made

relaying on 3 main elements :
Clinical features
Histological picture
IgA Anti-Endomysium (EMA), IgA Anti tissue
transglutinase (IgA Anti-tTGA), IgA Reticulin and IgA
Gliadin Auto-antibodies

 Linear IgA bullous Dermatosis

Bullous Pemphigoid

DD of Dermatitis
Herpetiformis

Etiology

Clinical
Manifestation

Dermatitis
Herpetiformis
(Duhring Disease)

Unknown,
autoimmune

Very itchy,
an erythematous
papul and group of
vesicle- large
bullae(herpetiformis),
symmetric.

Linear IgA Bullous

Dermatosis

Autoimmune

Small vesicles or big

bullae
symmetric

Bullous
Pemphygoid

Autoimmune

Bullae ( rigidity wall),

An erythematous
vesicle
Very itchy

Picture

Sistemic Therapy :
Dapsone (initial dosage 25-50 mg/day)
Sulfapyridine (1-5 g/day)
Diet :
Gluten Free Diet

 Intestinal lymphoma
Thyroid disorders

Disease runs along

Variable course remissions and exacerbations