Dühring's disease - alternate manifestations of celiac disease

First documented in the late 19th century, Düring's disease, like celiac disease, is an autoimmune disorder. It is primarily characterized by very itchy skin changes (such as vesicles and papules) and gluten-dependent enteropathy, which is usually clinically asymptomatic or oligosymptomatic. Herpetiform dermatitis is classified as a chronic disease with periods of exacerbation and remission. It often occurs in conjunction with other autoimmune disorders, such as systemic lupus erythematosus, type 1 diabetes, or Hashimoto's disease. Düring's disease can be diagnosed at any stage of life, but it most commonly affects children and young people, less frequently adults and older people. Men are more frequently affected than women.

The primary manifestation of Dühring's disease is the occurrence of patches, bumps, or blisters on the skin, which cause itching and sometimes pain. As a result, additional wounds and skin damage caused by scratching may appear on the body. The changes are usually small and extensive blistering is rarely observed. They are located symmetrically, most often on the forearms, elbows, knees, but also around the buttocks, lower part of the spine, pelvis, shoulders, and on the scalp. Furthermore, patients exhibit intestinal alterations linked to the consumption of gluten. These may be concealed, and digestive symptoms (diarrhea, bloating, etc.) only arise after excessive gluten intake and affect only about 10–20% of all patients.

In the case of suspected herpes-like skin inflammation, a biopsy is performed, which involves taking a tissue sample from the affected skin and analyzing it. In the case of Dühring's disease, a healthy skin sample is taken that is no further than 1 centimeter away from the skin change (often the biopsy is performed in the neck area). The analysis of the sample allows for the confirmation of the presence of this disease in almost 100% - the presence of IgA deposits in the dermis is detected, which is characteristic of Dühring's disease. Furthermore, an anti-endomysium antibody test is carried out, which enables the evaluation of intestinal disorders.

Treatment for Dühring's disease may encompass various methods, including pharmacological therapy and lifestyle changes. In pharmacotherapy, dapson is primarily used, a medication with immunosuppressive effects (reducing the body's defensive response). It is known for its very rapid action, leading to the disappearance of disease symptoms. However, not in every case is its application necessary, as in many cases, the introduction of a suitable nutritional model can lead to remission.