DERMATITIS HERPETIFORMIS-LIKE DERMATITIS -------------------------------------------------------- I need some help from this illustrious group of Dermatologists for a sweet 70 year old lady who has had a five month history of severely pruritic excoriated papules that begin with small blisters(I have yet to see them) by history. They are located on her scalp, upper chest,arms, elbows,gluteal cleft area and around her knees. She has seen 2 other derms who felt she had papular urticaria and contact dermatitis but she was totally refractory to oral antihistamines,topical steroids and lindane. A skin biopsy suggested that these were due to insect bites. I felt that she had Dermatitis Herpetiformis and began her on 100mg Dapsone bid and she promptly cleared and stopped itching. Unfortunately she developed serum sickness manifested by jaundice,malaise,myalgia, fever and elevated liver enzymes/bilirubin. Lab also revealed an eosinophilia of 7% and anemia. An immunoflourescence bx of normal skin was negative. Gluten free diet has not been helpful as she has again worsened since stopping the Dapsone. I still feel she has DH but my question is am I overlooking something and what is your suggested treatment for DH in a person allergic to sulfa meds. W H Burrow MD ------------- I have had a patient like this, it was multiple contact allergen dermatitis with systemic contact dermatitis exacerbation. The reaction to dapsone suggests possible sulfa allergy including to sulfa dyed foods, natural sources (e.g., garlic onion radish, etc), dyed and preserves skin care products, etc. The initial clearing could be initially from antigen excess. It takes a major effort to get someone to avoid sulfa in our society to the point that one can be in antibody excess and clear. James A. Solomon MD ------------------- I have also seen a number of patients with itchy papules knees, elbows, and scalp, that deeper sections of the pathology have revealed a folliculitis. I am planning to report this as DH- like folliculitis, but I need some clinical pictures. Klaus Helm, M.D. Assistant Prof. Penn State Univ. ---------------- Please consider a diagnosis of Subacute Prurigo as described in the German literature. Histo is insect bite, clinical is odd DH, and response is great to Dapsone. Consider Cholestyramine in this patient who cannot tolerate Dapsone, I do not know why it works, but, the Shelley's refer to it in their book, and it worked recently in one of my patients. Also, look for lymphoma, thryroid disease, including thyroid ca. Hope this helps. Diane Thaler MD --------------- ------- 4.24.96