If you have dermatitis herpetiformis, you know how uncomfortable this skin manifestation of celiac disease can be. People with dermatitis herpetiformis often scratch their skin until it bleeds in a futile effort to make the itching and burning stop.
About 15 to 25 percent of celiac disease patients also suffer from dermatitis herpetiformis, which appears as clusters of water-filled blisters and itchy red bumps. The skin rash most commonly erupts on the elbows, knees, lower back, buttocks, and on the back of the head, but it can appear anywhere on the body.
Although the only lifelong treatment for dermatitis herpetiformis is the gluten-free diet, it can take several weeks to several months of eating gluten-free until your rash subsides completely. Until then, your physician can prescribe the medication dapsone to control the itch and subdue the rash.
Dapsone for Dermatitis Herpetiformis Sufferers
Daposne, which was developed to treat leprosy and other skin infections, is a sulfur-based antibiotic that you'll take orally. It works quickly –- often within days –- to begin clearing up your dermatitis herpetiformis.Because dapsone can cause some serious side effects, your physician may start you on a small dose and ramp that dose up over time if needed as your symptoms begin to subside and as you get the hang of the gluten-free diet.
When taking dapsone, you might experience nausea and an upset stomach. To avoid these, take the medication with food or milk. In addition, the drug can make your skin more sensitive to sunlight, so be careful outdoors, especially in direct, strong sun.
Dapsone for DH: Rare, Serious Side Effects
All patients on dapsone see some reduction in their hemoglobin, the part of red blood cells that carries oxygen. This small drop in your hemoglobin won't hurt you. However, a few patients will experience a rapid decrease in their hemoglobin, which can cause symptoms including a sore throat, dizziness or feelings of faint. A very few patients also develop liver problems while taking dapsone.
If your physician prescribes dapsone to treat your dermatitis herpetiformis, you'll probably need to have weekly or bi-weekly blood tests for the first three months in order to make sure you're not developing these blood or liver problems related to the medication.
In addition, rare cases have been reported in which dapsone was associated with serious and potentially fatal skin reactions. If you develop any unusual rash while taking dapsone, talk to your doctor immediately.
Dapsone also can cause headaches in some people. Medical research hasn't determined if you can take it safely when you're pregnant, but it is known to pass into breast milk, so you should talk to your doctor if you are pregnant or nursing.
Options Available if Dapsone Fails to Clear Your Dermatitis Herpetiformis
If you can't tolerate dapsone or if it doesn't work for you, there are very few effective drug alternatives that might offer some relief while you're waiting for your gluten-free diet to take effect.
Dermatologists have used the medications sulfapyridine and tetracycline to treat dermatitis herpetiformis, although not as successfully as with dapsone. In addition, a report from Australia noted that sulfasalazine worked in three patients who couldn't tolerate dapsone, although one patient had to discontinue the drug due to side effects.
If you've been diagnosed with dermatitis herpetiformis, dapsone offers a short-term solution to intense discomfort. But the gluten-free diet represents your best long-term treatment.Sources:
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Dapsone. PubMed Health. Accessed Sept. 5, 2010. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000587.
Dermatitis Herpetiformis. American Osteopathic College of Dermatology. Accessed Sept. 5, 2010. http://www.aocd.org/skin/dermatologic_diseases/dermatitis_herpeti.html.
Linear IgA Disease. British Association of Dermatologists. Accessed Sept. 5, 2010. http://www.bad.org.uk/Portals/_Bad/Patient%20Information%20Leaflets%20%28PILs%29/Linear%20IgA%20Disease%20Update%20Apr%202010.pdf.
E. Willsteed et al. Sulfasalazine and dermatitis herpetiformis. Australasian Journal of Dermatology. 2005 May;46(2):101-3.
R. Wolf et al. Dapsone: Unapproved Uses or Indications. Clinics in Dermatology. 2000 January/February;18: 37-53.http://dermatology.cdlib.org/DOJvol8num1/reviews/dapsone/wolf.html.