[Glamour]

Autoimmune progesterone dermatitis (APD) is a circumstance in which the menstrual rhythm is associated with an amount of rind findings such as urticaria, eczema, angioedema, and others. The circumstance presents with a kind of rind eruptions characterized by cyclical recurrent premenstrual exacerbations payable to progesterone variation during the menstrual rhythm. Autoimmune progesterone dermatitis usually presents during early adult life, and the disease may periodically go into spontaneous remission. Exogenous progesterone (eg, in oral contraceptives containing progestational agents like norethindrone or synthetic progestogens like norgestrel or levonorgestrel) may aggravate the skin eruptions of autoimmune progesterone dermatitis. Some women with chronic urticaria experience cyclical exacerbations of their skin condition corresponding with the menstrual cycle, and it is possible that progesterone plays a role in this process.

Severity of symptoms can change from almost imperceptible to anaphylactic in nature, and symptoms can be liberal. There are no particular histological features on biopsy in autoimmune progesterone dermatitis. The age of onslaught is varying, with the earliest age reported at menarche. The symptoms of APD correlate with progesterone levels during the luteal phase of the menstrual cycle. Symptoms may first appear, improve, or worsen during pregnancy and the peripartum period. In addition, autoimmune progesterone dermatitis during pregnancy has been associated with spontaneous abortions. This disease may become worse during pregnancy. Autoimmune progesterone dermatitis must be differentiated from perimenstrual flares of skin diseases such as acne, dermatitis herpetiformis, erythema multiforme, lichen planus, lupus erythematosus, psoriasis and estrogen dermatitis.

The diagnosis of Autoimmune progesterone dermatitis requires a proper clinical story accompanied by an intradermal injection examination with progesterone. Autoimmune progesterone dermatitis is normally impervious to traditional therapy such as antihistamines. The use of systemic glucocorticoids, usually in high doses, has been reported to control the cutaneous lesions of APD is some studies, but not in others. Oral contraceptives are often tried as initial therapy, but have had limited success, possibly due to the fact that virtually all oral contraceptives have a progesterone component. Conjugated estrogens have also been used in the treatment of autoimmune progesterone dermatitis. Tamoxifen, a nonsteroidal antiestrogen agent, may be effective in some patients but may cause amenorrhea. In some cases, the eruptions often settle spontaneously after a period of successful treatment.

Digg!



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About The Author, Juliet Cohen


Juliet Cohen writes articles for health doctor. She also writes articles for haircut styles and beauty tips.

[Glamour]

Also seems Thyroid issues, perimenopause and other female hormonal imbalances, and in some cases general autoimmune diseases...all with no gluten intolerance or celiac disease present.

[Lisa]

DH is closely associated with Celiac Disease, but it's not exclusive to Celiac.

[Glamour]

Dermatitis Herpetiformis
Skin Changes in Celiac, Thyroid, Sjogren's, Arthritis, and More

© Elaine Moore
May 21, 2007
cells, cdc.gov
Dermatitis herpetiformis, once considered celiac disease of the skin, is known to occur in a number of different autoimmune disorders.

Dermatitis herpetiformis is an autoimmune disorder characterized by chronic, intensely pruritic (itchy) symmetric groups of vesicles, papules, and wheals (hives), that may occur on the elbows, knees, arms, legs, shoulders, scalp, buttocks, neck, and face. Dermatitis herpetiformis, which is also known as Duhrings’s disease, Brocq-During disease, and dermatitis multiformis, usually occurs in people with celiac disease and well as milder forms of gluten sensitivity, and less often, in people with autoimmune thyroid disorders.

Dermatitis herpetiformis has also been reported to occur in people with vitiligo, type I diabetes, Sjogren’s syndrome, dermatomyositis, and rheumatoid arthritis.

Who is Affected

Dermatitis herpetiformis has a typical onset in the late teens and early twenties, or in the third or fourth decades of life, although it can affect people of all ages. Males are affected twice as often as females, and it occurs more often in whites than in people of Asian or African descent.
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Symptoms

Dermatitis herpetiformis causes small blisters, discrete papules (bumps, pimples), itchy smooth lesions resembling hives, and waxy lesions. Blisters and papules frequently appear on the face and and may cause intense itching. Clinical signs are often highly variable ranging from groups of papulovesicles with excoriations or eczema-like lesions to minimal variants of discrete redness with small water blisters or areas of small purpura (purple bruise-like lesions).

Untreated, dermatitis herpetiformis tends to wax and wane although with a constant diet of gluten, symptoms persist. It can take a few weeks to several years for symptoms to clear with a gluten-free diet with longer periods required for patients who have had symptoms for a long time before restricting gluten.

Although lesions in the oral mucosa are rare, there are reports of oral lesions occurring early in the stages of dermatitis herpetiformis. These lesions may also be caused by the apthous ulcers (oral blisters) that frequently occur in people with celiac disease.

Environmental Triggers

Environmental triggers include gluten, which is found in wheat, rye, and barley, and other grains that are contaminated with wheat during harvest. Gluten is also found in hydrolyzed vegetable protein, artificial colorings, malts, malt ales, hydrolyzed plant protein, monosodium glutamate, preservatives, modified food starches, vegetable gum, beer, and vinegar. Iodide in iodized salt and foods high in iodine and halide are suspected of causing disease flares.

Diagnosis

Biopsy of the lesions in dermatitis herpetiformis shows dermal papillary microsabscesses of neutrophilic white blood cells with deposits of immunoglobulin A (IgA) and complement at the junction of the dermal and epidermal layers of the skin.
Treatment

Treatment for dermatitis herpetiformis includes: the antibiotics dapsone and sulfapyridine, and a gluten free diet. Dapsone effectively reduces the rash within several days. However, long-term use can result in anemia. A gluten-free diet generally limits the need for continued dapsone use. Often, dapsone is used initially to reduce inflammation and symptoms are controlled, often resolving after 18 months of a gluten-free diet. However, symptoms often return over time when gluten is resumed. In autoimmune thyroid disease, reduction of thyroid antibodies offers benefits. Recent studies show the effectiveness of selenium in reducing thyroid peroxidase (TPO) antibody titers.

Although dermatitis herpetiformis usually occurs for life once it appears, permanent remission is reported to occur in 10-20 percent of patients, usually after long-term adherence to a gluten-free diet.

Resources:

Dermatitis Herpetiformis, Dermatologic Disease Database, American Osteopathic College of Dermatology, accessed May 17, 2007.

Sharon Longshore and Kenneth Tomecki, Skin Signs of Systemic Disease, August 4, 2004, Medicine Index, The Cleveland Clinic.

Nino M, Ciacci C, and Delfino M, A long-term gluten-free diet as an alternative treatment in severe forms of dermatitis herpetiformis, J Dermatolog Treat, 2007; 18(1):10-12.

The copyright of the article Dermatitis Herpetiformis in Autoimmune Skin Disorders is owned by Elaine Moore. Permission to republish Dermatitis Herpetiformis in print or online must be granted by the author in writing.


cells, cdc.gov
cells

[Glamour]

Scary, because what if going gluten-free does not help it. What treatment would be available for non-celiac DH?

[Fiddle-Faddle]

Glamour, the author of that article didn't mention ruling out celiac disease/gluten intolerance, or wheat allergy, either, for that matter. Since celiac disease has been shown to disrupt menstrual cycles, it could certainly be a factor in this "autoimmune progesterone dermatitis." It could even be the cause.

Many of us here on this board have had a variety of diagnoses of all kinds of autoimmune disorders that turned out to have been directly triggered by gluten.

[ravenwoodglass]

Fiddle-Faddle, on Nov 13 2009, 06:12 AM, said:

Glamour, the author of that article didn't mention ruling out celiac disease/gluten intolerance, or wheat allergy, either, for that matter. Since celiac disease has been shown to disrupt menstrual cycles, it could certainly be a factor in this "autoimmune progesterone dermatitis." It could even be the cause.

Many of us here on this board have had a variety of diagnoses of all kinds of autoimmune disorders that turned out to have been directly triggered by gluten.

Exactly what I was going to say.

[momxyz]

all I know is that my rash didn't start to heal until I eliminated gluten from my diet....

[ChemistMama]

Quote

DH is closely associated with Celiac Disease, but it's not exclusive to Celiac.

Totally wrong. The title of this thread is misleading...dermatitis herpetiformis IS necessarily caused by gluten. That is the definition of DH. If something else is causing it is not DH, but another type of dermatitis. IN medical terms, gluten is a 'necessary cause' of DH. It has to be there for the DH symptoms to appear.

What the article posted is referring to is the observation that the onset of DH has been caused by people taking various drugs, like progesterone. This is called a 'precipitating cause'; it's a trigger that brings on the disease. Think of it like this: there are lots of stories on the 'net about people getting celiac after a major surgery or car accident or after having a baby; those things really can mess up your body physically. When they heal or have the baby, the celiac doesn't go away; the event is the precipitating cause of celiac. The same goes for DH.

What is confusing is that most people with DH never have celiac symptoms, which makes them think they don't have celiac disease. However, the same mechanism is taking place: when a celiac eats gluten, the antibodies start destroying their intestines. In DH, those same antibodies attack your skin. I like to call DH "celiac's just-as-evil-twin". That is why if you have DH, the new celiac drug that is in clinical tests (AT-1001) will work for you, since it acts against those same celiac antibodies (this is straight from a Q&A I had with Dr. Fasano, the Dr. working on the drug).


Here's a DH link with a reference to progesterone...

emedicine DH link

...and here's a link to the many different medical definitions of 'cause' :

Medical Defn's of 'cause'

[Lisa]

http://autoimmune-skin-disorders.suite101....s_herpetiformis

Dermatitis herpetiformis is an autoimmune disorder characterized by chronic, intensely pruritic (itchy) symmetric groups of vesicles, papules, and wheals (hives), that may occur on the elbows, knees, arms, legs, shoulders, scalp, buttocks, neck, and face. Dermatitis herpetiformis, which is also known as Duhrings’s disease, Brocq-During disease, and dermatitis multiformis, usually occurs in people with celiac disease and well as milder forms of gluten sensitivity, and less often, in people with autoimmune thyroid disorders.
Dermatitis herpetiformis has also been reported to occur in people with vitiligo, type I diabetes, Sjogren’s syndrome, dermatomyositis, and rheumatoid arthritis.



Read more: http://autoimmune-skin-disorders.suite101....s#ixzz0WlCmvdZt


It has always been my understanding that DH can be present in other autoimmune issues, to include Celiac, but not exclusive too. Celiac Disease takes place in the small intestines and DH is a manifestation of a gluten response on the skin. Both can be controlled by a gluten free diet, but yet, they are not the same.

[Swimmr]

Glamour, on Nov 12 2009, 09:50 PM, said:

Often, dapsone is used initially to reduce inflammation and symptoms are controlled, often resolving after 18 months of a gluten-free diet. However, symptoms often return over time when gluten is resumed.

Stands to reason that someone wouldn't go back to eating gluten if they were free of DH while gluten-free...DUH

[ravenwoodglass]

Lisa, on Nov 13 2009, 10:08 AM, said:

Celiac Disease takes place in the small intestines and DH is a manifestation of a gluten response on the skin. Both can be controlled by a gluten free diet, but yet, they are not the same.

I do have to disagree with this. Celiac antibodies can attack pretty much any organ of the body. While it is true that some with DH will not have gut symptoms they do still have celiac. In additon at times the gut symptoms may be mild for awhile or may present in ways that are not just the D that most of us think of. It wasn't a coincedence that when I developed DH in childhood I also developed depressive episodes and constipation along with a stomach that growled constantly. It wasn't until after I went gluten free that I realized that gluten was involved with much more than my by then constant D.

[Lisa]

ravenwood glass, on Nov 13 2009, 12:53 PM, said:

Celiac antibodies can attack pretty much any organ of the body.

I agree 100%, a gluten induced autoimmune response can be found in many parts of the body. But when it occurs in the small intestines, it's called Celiac. DH is a gluten induced autoimmune response in the skin, Cerebral Ataxia can effect the muscles and the brain. I'm just saying that where is manifests itself, carries a different name and reference.

I'm just saying that those with Celiac do not necessarily have DH and those with DH do not necessarily have Celiac. Both are controlled by a gluten free diet, but that does not make them the same, in my opinion.

[ChemistMama]

Lisa, on Nov 13 2009, 12:08 PM, said:

Dermatitis herpetiformis is an autoimmune disorder characterized by chronic, intensely pruritic (itchy) symmetric groups of vesicles, papules, and wheals (hives), that may occur on the elbows, knees, arms, legs, shoulders, scalp, buttocks, neck, and face. Dermatitis herpetiformis, which is also known as Duhrings’s disease, Brocq-During disease, and dermatitis multiformis, usually occurs in people with celiac disease and well as milder forms of gluten sensitivity, and less often, in people with autoimmune thyroid disorders.
Dermatitis herpetiformis has also been reported to occur in people with vitiligo, type I diabetes, Sjogren’s syndrome, dermatomyositis, and rheumatoid arthritis.

Read more: http://autoimmune-skin-disorders.suite101....s#ixzz0WlCmvdZt


It has always been my understanding that DH can be present in other autoimmune issues, to include Celiac, but not exclusive too. Celiac Disease takes place in the small intestines and DH is a manifestation of a gluten response on the skin. Both can be controlled by a gluten free diet, but yet, they are not the same.

Yes, DH can be present with other autoimmune issues, but that means that person also has celiac disease.

Note that the article referenced above was written not by a doctor, but by a medical technologist/writer with a B.S. in medical technology. Therefore not an expert in celiac or DH.

Here's one of the best defn's of DH I've found in awhile:

"Dermatitis herpetiformis is a rare disease that should be considered the cutaneous expression of a gluten-sensitive enteropathy indistinguishable from celiac disease."

abstract


I strongly recommend reading a brief history of research on DH at Duke University here:
The Skin-Gut Connection

[ravenwoodglass]

Lisa, on Nov 13 2009, 11:06 AM, said:

I'm just saying that those with Celiac do not necessarily have DH and those with DH do not necessarily have Celiac. Both are controlled by a gluten free diet, but that does not make them the same, in my opinion.

And you are entitled to your opinion. Please do check the link provided by the previous poster and also check out what the NIH has to say about it here

http://www.celiac.ni...Dermatitis.aspx

"Clusters of small blisters that persistently break out on the elbows, knees, buttocks, back, or scalp. These symptoms are the hallmarks of dermatitis herpetiformis (DH), a skin manifestation of celiac disease. DH affects 15 to 25 percent of people with celiac disease, and these people typically have no digestive symptoms of the disease."

It is not just an opinion of mine that folks with DH are celiac. It is also the findings of the NIH as well as other medical research.