What is dermatitis herpetiformis. How is it related to gluten intolerance. What are the main symptoms of this skin condition. How is dermatitis herpetiformis diagnosed and treated. Can a gluten-free diet help manage dermatitis herpetiformis.

Understanding Dermatitis Herpetiformis: A Gluten-Induced Skin Condition

Dermatitis herpetiformis (DH) is a chronic skin condition characterized by an intensely itchy rash. It’s closely linked to gluten intolerance and often associated with celiac disease. This autoimmune disorder affects approximately 1 in 10,000 people, with a higher prevalence in men and typically onset between ages 30-50, though it can occur at any age.

Is dermatitis herpetiformis always accompanied by celiac disease? While most individuals with DH have some degree of celiac disease, they may not always experience noticeable gastrointestinal symptoms. In fact, DH can sometimes be the first indication of underlying celiac disease.

The Root Cause: Gluten Intolerance and Immune System Response

At the core of dermatitis herpetiformis lies gluten intolerance. When individuals with this condition consume gluten – a protein found in wheat, rye, and barley – their immune system reacts abnormally. Instead of defending against infections, it attacks the body’s own tissues, particularly affecting the skin in the case of DH.

Does gluten intolerance only affect the skin in DH? No, gluten intolerance can also cause inflammation in the small intestine, leading to celiac disease. This highlights the systemic nature of gluten sensitivity and its potential to impact multiple organs.

The Immune System’s Role in DH

In dermatitis herpetiformis, the immune response to gluten triggers the production of antibodies that attack the skin. This autoimmune reaction leads to the formation of the characteristic itchy rash and blisters associated with DH.

Recognizing the Symptoms: The Telltale Signs of Dermatitis Herpetiformis

The hallmark symptom of dermatitis herpetiformis is an extremely itchy rash that typically appears symmetrically on both sides of the body. Common areas affected include:

• Elbows
• Knees
• Buttocks
• Scalp

The rash manifests as blisters and raised spots (papules), often accompanied by a burning or stinging sensation before the blisters appear. Due to intense itching, blisters are frequently scratched off, leaving scabs.

Can the symptoms of dermatitis herpetiformis vary over time? Yes, the intensity and appearance of the rash can fluctuate from week to week. However, without proper treatment, it rarely clears up on its own.

Beyond the Skin: Other Potential Symptoms

While skin manifestations are the primary symptoms of DH, some individuals may also experience signs of celiac disease, such as:

• Abdominal discomfort
• Unexplained fatigue
• Digestive issues

It’s important to note that not all individuals with DH will exhibit gastrointestinal symptoms, emphasizing the need for comprehensive evaluation and diagnosis.

Diagnosing Dermatitis Herpetiformis: From Suspicion to Confirmation

Accurate diagnosis of dermatitis herpetiformis is crucial for effective management. The diagnostic process typically involves several steps:

1. Clinical examination of the rash
2. Skin biopsy
3. Blood tests for celiac disease markers
4. Possible intestinal biopsy to confirm celiac disease

How is a skin biopsy performed for diagnosing DH? A small sample of skin is taken under local anesthesia. This sample is then examined microscopically using a special test to detect IgA antibodies, which are characteristic of dermatitis herpetiformis.

The Role of Celiac Disease Testing

Given the strong association between DH and celiac disease, individuals suspected of having dermatitis herpetiformis are often screened for celiac disease as well. This may involve blood tests to detect specific antibodies associated with celiac disease. If these tests are positive, a small intestine biopsy may be recommended to confirm the diagnosis of celiac disease.

Treatment Approaches: Managing Dermatitis Herpetiformis Effectively

The treatment of dermatitis herpetiformis focuses on two main aspects:

1. Dietary modifications
2. Medication

Dietary Intervention: The Gluten-Free Approach

A strict gluten-free diet is the cornerstone of long-term management for both dermatitis herpetiformis and celiac disease. By eliminating gluten from the diet, individuals can gradually reduce DH symptoms and potentially achieve complete remission.

How long does it take for a gluten-free diet to improve DH symptoms? The response to dietary changes can vary significantly among individuals. While some may notice improvements within weeks, for others, it may take months or even years to see substantial benefits. This gradual response underscores the importance of patience and consistency in adhering to a gluten-free lifestyle.

Medication: Providing Rapid Symptom Relief

Given the potentially slow response to dietary changes, medication is often prescribed to provide more immediate relief from DH symptoms. The most commonly used medication is dapsone, an antibiotic that also has anti-inflammatory properties.

How does dapsone work in treating dermatitis herpetiformis? Dapsone helps to quickly alleviate the itching and blistering associated with DH. Many patients experience significant improvement within days of starting treatment. However, it’s important to note that dapsone does not address the underlying cause of the condition and is typically used in conjunction with a gluten-free diet for optimal results.

Living with Dermatitis Herpetiformis: Long-Term Management and Considerations

Managing dermatitis herpetiformis is a long-term commitment that requires a multifaceted approach. Here are some key considerations for individuals living with DH:

• Strict adherence to a gluten-free diet
• Regular medical follow-ups
• Monitoring for potential complications
• Awareness of hidden sources of gluten
• Emotional support and coping strategies

Can individuals with DH ever reintroduce gluten into their diet? Generally, it’s not recommended to reintroduce gluten once a diagnosis of DH has been made. Even small amounts of gluten can trigger symptoms and potentially lead to complications. Lifelong adherence to a gluten-free diet is typically necessary for optimal health and symptom management.

Potential Complications and Vigilance

While dermatitis herpetiformis itself is not life-threatening, individuals with this condition may be at increased risk for certain complications, particularly if left untreated or if gluten exposure continues. These potential complications include:

• Nutritional deficiencies
• Increased risk of certain gastrointestinal cancers
• Osteoporosis
• Fertility issues

Regular medical check-ups and adherence to treatment recommendations can help minimize these risks and ensure overall health and well-being.

The Prognosis: What to Expect with Proper Management

With appropriate treatment and lifestyle modifications, the prognosis for individuals with dermatitis herpetiformis is generally positive. Many people experience significant improvement in their symptoms and quality of life once they adopt a gluten-free diet and, if necessary, incorporate medication into their treatment plan.

Is it possible to achieve complete remission of dermatitis herpetiformis? Yes, some individuals may achieve complete remission of their DH symptoms with strict adherence to a gluten-free diet. However, it’s important to note that this process can take time, and ongoing vigilance is necessary to maintain symptom-free status.

The Importance of Ongoing Support and Education

Living with dermatitis herpetiformis and maintaining a gluten-free lifestyle can be challenging. Ongoing support from healthcare providers, support groups, and educational resources can be invaluable in navigating the complexities of this condition. Some helpful strategies include:

• Working with a registered dietitian specializing in gluten-free diets
• Joining support groups for individuals with DH or celiac disease
• Staying informed about new research and treatment options
• Developing strategies for eating out and traveling while maintaining a gluten-free diet

By staying informed and proactive in their care, individuals with dermatitis herpetiformis can effectively manage their condition and lead fulfilling, symptom-controlled lives.

Advances in Research: New Horizons in Dermatitis Herpetiformis Treatment

The field of dermatitis herpetiformis research is dynamic, with ongoing studies aimed at improving diagnosis, treatment, and quality of life for affected individuals. Some areas of current research include:

• Development of new diagnostic tools for earlier detection
• Exploration of alternative medications with fewer side effects
• Investigation of potential immunomodulatory therapies
• Studies on the genetic factors contributing to DH and celiac disease

What promising new treatments are on the horizon for dermatitis herpetiformis? While research is ongoing, some potential future treatments being explored include enzymes that break down gluten in the digestive tract, immunotherapies to modulate the immune response to gluten, and targeted therapies to address the specific autoimmune mechanisms involved in DH.

The Role of Genetic Research

Genetic studies are shedding light on the hereditary factors that contribute to the development of dermatitis herpetiformis and celiac disease. This research may lead to improved risk assessment and potentially even preventive strategies for individuals with a genetic predisposition to these conditions.

Understanding the genetic basis of DH could also pave the way for more personalized treatment approaches, tailoring interventions to an individual’s specific genetic profile.

Beyond the Physical: The Psychological Impact of Dermatitis Herpetiformis

While much focus is placed on the physical symptoms and management of dermatitis herpetiformis, it’s crucial to acknowledge the potential psychological and emotional impact of living with this chronic condition. The visible nature of the rash, dietary restrictions, and the need for ongoing management can all contribute to psychological stress.

How can individuals cope with the emotional challenges of living with DH? Some strategies for managing the psychological aspects of dermatitis herpetiformis include:

• Seeking support from mental health professionals familiar with chronic health conditions
• Participating in support groups to connect with others facing similar challenges
• Practicing stress-reduction techniques such as mindfulness or meditation
• Focusing on self-care and maintaining overall well-being
• Educating friends and family about the condition to foster understanding and support

The Importance of a Holistic Approach

Adopting a holistic approach to managing dermatitis herpetiformis that addresses both physical and emotional well-being can lead to improved overall outcomes and quality of life. Healthcare providers play a crucial role in not only managing the physical symptoms but also in providing resources and support for the psychological aspects of living with DH.

By addressing both the physical and emotional dimensions of dermatitis herpetiformis, individuals can develop a comprehensive management strategy that promotes overall health and well-being.

Dermatitis Herpetiformis: Causes, Diagnoses, and Treatment

In this series Coeliac Disease Gastrointestinal Malabsorption

Dermatitis herpetiformis is a skin condition where you develop a very itchy rash. It is caused by intolerance to a food ingredient called gluten. It can be effectively treated with medication plus a gluten-free diet. Dermatitis herpetiformis is linked to a condition called coeliac disease, which is also caused by gluten intolerance. Treatment for both conditions is often needed.

Dermatitis Herpetiformis

In this article

• What is dermatitis herpetiformis?
• What causes dermatitis herpetiformis?
• How common is dermatitis herpetiformis?
• What are the symptoms of dermatitis herpetiformis?
• How is dermatitis herpetiformis diagnosed?
• How is dermatitis herpetiformis treated?
• Are there any possible complications?
• What is the prognosis?

What is dermatitis herpetiformis?

Dermatitis herpetiformis (DH) is a skin condition causing a very itchy rash. It is due to intolerance to gluten, which is a natural substance (a protein) found in certain foods. Gluten is in wheat, rye and barley. Gluten intolerance also causes a gut condition called coeliac disease, which is closely linked to DH.

What causes dermatitis herpetiformis?

The cause of dermatitis herpetiformis is gluten intolerance. In this condition, your body reacts to gluten in food. Gluten intolerance is also sometimes called gluten sensitivity.

People with gluten intolerance have a kind of allergy to gluten, but it is not the same as a typical food allergy. With gluten intolerance, the gluten somehow triggers your body’s immune system to react against the body’s own organs.

This is instead of doing what the immune system normally does, which is to be a defence against infections, etc. This may lead to various symptoms in different parts of your body. With dermatitis herpetiformis, it is your skin which is affected.

It is not known exactly what causes the gluten intolerance in the first place.

Does dermatitis herpetiformis always mean you have coeliac disease?

Gluten intolerance also usually causes inflammation in the gut (in the small intestine). When this happens it is called coeliac disease. Most people with dermatitis herpetiformis have some degree of coeliac disease. However, they may not have had any noticeable symptoms and their coeliac disease may not have been diagnosed. See the separate leaflet called Coeliac Disease for more details.

The rest of this leaflet deals with dermatitis herpetiformis.

How common is dermatitis herpetiformis?

• Around 1 in 10,000 people have dermatitis herpetiformis. About 1 in 8 people with coeliac disease will have DH.
• Dermatitis herpetiformis is more common in men than in women and usually starts between ages 30-50 years, although it can occur at any age.

What are the symptoms of dermatitis herpetiformis?

There is an extremely itchy rash. It can affect any part of your skin, but is usually on your elbows, knees, buttocks and scalp. The rash is usually on both sides of your body at the same time (symmetrical). The rash has blisters and/or raised spots (papules) – but the blisters usually get scratched off to leave scabs. There may be burning or stinging on the area before the blisters start.

The rash can vary from week to week but does not usually clear up without treatment.

Dermatitis herpetiformis rash

Madhero88, CC BY-SA 3.0, via Wikimedia Commons

By Madhero88, CC BY-SA 3.0, via Wikimedia Commons

You may also have symptoms of coeliac disease, such as tummy (abdominal) symptoms or unexplained tiredness. However, some people with coeliac disease have little in the way of symptoms, and dermatitis herpetiformis may be the first sign of coeliac disease.

How is dermatitis herpetiformis diagnosed?

There are various skin conditions that cause itchy rashes with blisters, so a test is needed to diagnose dermatitis herpetiformis for certain. The test is a a skin biopsy. This involves taking a small sample of skin under local anaesthetic. The sample is examined under the microscope in a laboratory, using a special test to look for antibodies called IgA. This test can reliably diagnose DH.

If dermatitis herpetiformis is suspected, you will usually be offered tests for coeliac disease as well. Blood tests can help to show if coeliac disease is likely. If the blood tests are positive, you may be offered a test on the gut (a biopsy to sample the lining of your bowel), which can confirm if you have coeliac disease.

How is dermatitis herpetiformis treated?

There are two treatments for dermatitis herpetiformis:

• Diet.
• Medication.

Diet

In the long term, a diet free of gluten will gradually reduce the dermatitis herpetiformis symptoms and may cure DH completely. (This diet also treats coeliac disease.) However, it can take months or years for the diet to improve DH. Therefore, medication is often needed to bring the skin symptoms under control. See the separate leaflet called Coeliac Disease Diet Sheet for more information about the gluten-free diet. In the UK more information is also available from Coeliac UK – see under ‘Further Reading and References’, below.

Medication

Medication helps control the rash quickly. The usual medication for dermatitis herpetiformis is dapsone. Dapsone often stops the itching within two days. Dapsone may have side-effects, including anaemia. Therefore, regular check-ups and blood tests are needed while you are taking it.

Dapsone is used to treat certain skin conditions, including DH. Exactly how it works is not known. However, it seems to have anti-inflammatory and antibacterial actions. In dermatitis herpetiformis, it is probably the anti-inflammatory action that is helpful.

If you cannot take dapsone or you have side-effects from it, other alternative medicines are available – for example, sulfasalazine or sulfapyridine.

Are there any possible complications?

Dermatitis herpetiformis itself does not usually cause complications. However, the gluten intolerance and coeliac disease, if untreated, may make you ill and have possible complications. Most of these problems can be prevented or treated by following a gluten-free diet, which treats both dermatitis herpetiformis and coeliac disease.

What is the prognosis?

Untreated, dermatitis herpetiformis tends to go up and down in severity, but usually continues.

With treatment, the outlook (prognosis) is very good, as dermatitis herpetiformis clears up with medication and a gluten-free diet. Dapsone usually improves the rash quickly. The gluten-free diet takes longer to help – it may take a year or more to get the full benefit. About 8 in 10 people with dermatitis herpetiformis have good results from the diet so they can either stop taking dapsone, or can reduce the dose.

• Reunala T, Hervonen K, Salmi T; Dermatitis Herpetiformis: An Update on Diagnosis and Management. Am J Clin Dermatol. 2021 May22(3):329-338. doi: 10.1007/s40257-020-00584-2.

• Mirza HA, Gharbi A, Bhutta BS; Dermatitis Herpetiformis.

• Coeliac UK

Urticaria and urticaria-like conditions | DermNet

Introduction

This topic provides a differential diagnosis for urticaria and for urticaria-like conditions that resemble urticaria but are not caused by wealing.

What is urticaria?

Urticaria describes a group of conditions in which there are weals (or weals) in the skin, itchy white or red lumps. Urticaria can occasionally be a sign of systemic disease.

Ordinary urticaria

Spontaneous or ‘ordinary’ urticaria is divided into acute urticaria (lasting a few hours or days or up to six weeks) and chronic urticaria (persisting more than six weeks, and sometimes life-long).

• Acute urticaria is self-limiting and often related to infection, and less often due to food or is drug-induced.
• Chronic urticaria has no specific external cause (thus ‘spontaneous’) and is considered autoimmune in most cases.
• Ordinary urticaria may be accompanied by angioedema.

The weals are well defined raised lesions with a smooth surface. They may be red or white, surrounded by a red or white flare. Weals range in size from a few millimetres to many centimetres in diameter. The shape also varies: round, polycyclic (overlapping circles), annular (ring-shaped), geographic (like a map). They are randomly distributed on the body and may affect any site. They last no more than 24 hours and do not leave any marks behind.

Ordinary urticaria: asymmetrical weals that clear within 24 hours

See more about ordinary urticaria.

Inducible urticaria

Chronic inducible urticaria (previously known as physical urticaria) arises in response to an external factor. Classification is according to the provoking factor: stroking the skin in dermographism (skin writing), acetylcholine released during sweating in cholinergic urticaria, cold air or water in cold urticaria, local heat in heat urticaria, a contact factor in contact urticaria, water of any type or temperature in aquagenic urticaria, sun exposure in solar urticaria and firm pressure in delayed pressure urticaria. Physical urticarias have the following characteristics.

• Weals are induced at the site of the provoking factor
• Weals last about 15 minutes, nearly always less than one hour (with the exception of delayed pressure urticaria, which lasts hours to days)

Inducible urticaria: short-lasting weals at the site of provoking factor

Dermographism

Solar urticaria provoked experimentally

Cold urticaria provoked by ice cube

What are urticaria-like skin lesions?

Urticaria-like skin lesions are reddish or skin-coloured flat patches or swellings with a smooth surface that persist for more than 24 hours.

Insect bites

Insect bites often result in itchy bumps (papules) or weals. Their characteristics include:

• Initial sting is often felt
• On exposed sites
• Central blister (vesicle)
• Groups of lesions, often distributed asymmetrically
• More commonly arise in summer and autumn months
• Individual lesions persist for days to weeks
• Brownish discolouration that persists for months is often seen in a skin that tans easily.

Children and, less frequently, adults may develop papular urticaria, which is interpreted as a hypersensitivity reaction to insect bites. No initial sting is felt, and old lesions may reappear.

A biopsy reveals an inflammatory infiltrate that includes eosinophils and spongiosis of the epidermis.

Insect bites: grouped urticarial lesions with central punctum or blister

Insect bites

Insect bites

Insect bites

Urticarial dermatitis

Urticarial dermatitis presents with both urticaria-like and eczema-like lesions.

• Urticarial dermatitis usually affects elderly patients
• Persistent red itchy plaques may have a smooth surface (urticaria-like) or dry scratched surface (eczema-like)
• They are distributed symmetrically on the trunk, upper arms and thighs
• In some cases, urticarial dermatitis is an adverse reaction to a drug.

A biopsy may be reported as dermal dermatitis with mixed inflammatory cells in the dermis and minimal spongiosis in the epidermis.

Urticarial dermatitis can be an early sign of bullous pemphigoid. Eventually, tense blisters appear. Biopsy features eosinophils and subepidermal clefting with positive staining on direct immunofluorescence.

Urticarial dermatitis: persistent red plaques with a smooth or dry surface

Urticarial dermatitis

Urticarial dermatitis

Urticarial dermatitis

Contact dermatitis

Contact dermatitis sometimes appears urticarial rather than eczematous, with most of the inflammation in the dermis rather than the more superficial epidermis.

• It appears at the site of contact with the responsible agent
• It may arise in irritant contact dermatitis or allergic contact dermatitis
• Lesions clear up over days to weeks
• Patch tests may reveal an allergen in allergic cases

Contact dermatitis should be distinguished from contact urticaria, which is a short-lasting type of physical urticaria (see above).

Contact dermatitis: sometimes predominantly dermal

Dermal contact dermatitis

Dermal contact dermatitis

Dermal contact dermatitis

Erythema multiforme

Classic erythema multiforme presents with an acute eruption of target-shaped lesions on the hands, feet, knees and elbows. However target-shaped lesions may also be seen in ordinary urticaria.

• Target lesions are urticaria-like plaques characterised by concentric rings
• In erythema multiforme, blisters often arise in the centre of the plaques
• Individual lesions persist for ten days to 3 weeks
• Mucosal lesions occur in more severe cases
• Erythema multiforme may be recurrent, usually due to herpes simplex virus infection

A biopsy is usually characteristic.

Erythema multiforme: crops of target lesions on hands and knees

Erythema multiforme

Erythema multiforme

Erythema multiforme

Urticarial drug eruptions

Drug eruptions include urticaria and urticaria-like eruptions. Individual lesions resolve within hours in drug-induced urticaria and persist for days in urticaria-like eruptions. They are often described as morbilliform or maculopapular eruptions. Characteristics of drug eruptions include:

• The rash starts within 14 days of a new medication (except in drug hypersensitivity syndrome, when they arise within eight weeks of starting a new medication)
• They arise sooner on re-challenge
• The medication may have already been stopped when the rash appears
• Red macules (small flat spots) and papules (small raised spots) may merge to form large patches (large flat areas) and plaques (large raised areas)
• The rash is symmetrical and tends to be most severe on the trunk
• The rash may or may not be itchy
• There may or may not be a low-grade fever
• As the lesions fade, the surface peels
• Dark marks may persist for days to weeks

A biopsy reveals a subtle inflammatory infiltrate that includes eosinophils, and lymphocytes and apoptotic keratinocytes in the epidermis.

Drug eruptions: symmetrical urticated papules and plaques

Drug eruption

Drug eruption

Drug eruption

Urticaria pigmentosa

Urticaria pigmentosa is a form of cutaneous mastocytosis in which there are brown macules and papules.

• Urticaria pigmentosa is mostly seen in infants and improves with age
• It may also arise in adults when it tends to persist
• Lesions may affect trunk and limbs, and less often scalp and face
• The lesions urticate when they are rubbed, or spontaneously, i.e. the papules swell into weals, and these persist for up to an hour
• Lesions may blister in young children
• There may be few to hundreds of lesions
• Systemic involvement may result in flushing and faintness

A biopsy may reveal increased numbers of mast cells, but these can be difficult to identify, and the tissue may look the same as normal skin.

Urticaria pigmentosa: brown spots that urticate

Urticaria pigmentosa

Autoimmune blistering diseases

The subepidermal autoimmune blistering diseases may initially present with urticarial lesions several days or weeks before blisters appear. These urticarial lesions may be seen in:

• Bullous pemphigoid
• Pemphigoid gestationis (pemphigoid associated with pregnancy)
• Linear IgA bullous dermatosis
• Epidermolysis bullosa acquisita

The characteristics of autoimmune blistering diseases include:

• Symmetrical distribution
• A tendency to involve trunk and skin folds (flexures)
• Often affects the elderly (pemphigoid) or pregnant patient (pemphigoid gestationis).

Skin biopsy for routine histopathology and direct immunofluorescence studies are necessary to confirm the diagnosis.

Urticarial plaques in autoimmune blistering diseases

Bullous pemphigoid

Bullous pemphigoid

Pemphigoid gestationis

Pruritic urticarial papules and plaques of pregnancy

PUPPP or Pruritic Urticarial Papules and Plaques of Pregnancy is an eruption occurring during the last few weeks of pregnancy, usually in a first pregnancy.

• Small pink papules may join to form plaques
• Urticarial lesions are most common, but eczematous and blistered plaques may also arise
• Lesions mostly affect the trunk, upper arms and thighs
• The spots usually start in the stretch marks (striae gravidarum)
• PUPPP clears up within a few weeks of delivery

PUPPP: symmetrical urticated plaques favouring stretch marks

Polymorphic eruption of pregnancy PUPPP

PUPPP polymorphous eruption of pregnancy

PUPPP polymorphous eruption of pregnancy

Annular erythema

Annular erythema usually begins as a small raised pink-red spot that slowly enlarges and forms a ring shape while the central area flattens and clears. They may resemble an urticarial weal but often have a trailing scale. They are asymptomatic. The rings enlarge at a rate of about 2-5 mm/day until they reach a diameter of about 6-8 cm. Sometimes the lesions do not form complete rings but grow into irregular shapes.

Annular erythema: slowly enlarging rings

Annular erythema

Annular erythema

Annular erythema

Autoimmune progesterone dermatitis

Autoimmune progesterone dermatitis is a rare, recurrent and itchy rash affecting women during their childbearing years.

• Skin lesions appear during the second half of the menstrual cycle and resolve during the menstrual period
• Urticaria, urticaria-like weals, eczema-like lesions, blisters and target lesions may occur
• It is prevented when ovulation is prevented by an oral contraceptive agent

Interstitial granulomatous dermatitis

Interstitial granulomatous dermatitis is a distinctive pathological entity of an unusual persistent skin eruption often of an urticarial type. Other lesions described with the same pathology include papules, nodules and plaques that are skin coloured, red or brown. These may be oval, annular or cord-like.

Interstitial granulomatous dermatitis is associated with autoimmune diseases, particularly seronegative polyarthritis, and is occasionally seen in association with lymphoma, lung cancer, drugs and infections

Interstitial granulomatous dermatitis

Interstitial granulomatous dermatitis

Interstitial granulomatous dermatitis

Interstitial granulomatous dermatitis

Wells syndrome

Wells syndrome, also called eosinophilic dermatitis, also presents with urticarial lesions. Eosinophils are seen in the blood in 50% of patients.

• The lesions may be confined to one site or more generalised
• Individual lesions are itchy red to purple, swollen papules or plaques that resolve over days to weeks
• They may resemble insect bites or cellulitis
• Lesions may be followed by brown marks that last for weeks to months
• Blisters may arise within the lesions
• Lesions may recur in the same site

Skin biopsy is characterised by eosinophils and flame figures.

Wells syndrome

Wells syndrome

Neutrophilic eccrine hidradenitis

Neutrophilic eccrine hidradenitis is a rare condition occurring in patients with acute myelogenous leukaemia, either while on or after receiving chemotherapy.

• Solitary or grouped urticaria-like papules and plaques are associated with fever

Skin biopsy reveals neutrophils around the eccrine sweat glands and some destruction of eccrine cells.

Neutrophilic eccrine hidradenitis: irregular urticated plaques with fever in chemotherapy patient

Neutrophilic eccrine hidradenitis

Urticaria – as a feature of a systemic disease

Patients with ordinary urticaria do not usually have systemic symptoms, so if these are present, other diagnoses should be considered.

Scombroid fish poisoning

Sudden onset of a red itchy rash within 30 minutes of consuming decomposing scombroid fish may be due to scombroid fish poisoning in which large amounts of histamine are ingested. Unlike urticaria, there are no weals. Other symptoms include a headache, palpitations, nausea, diarrhoea and collapse.

Scombroid fish poisoning (tuna)

Scombroid rash

Scombroid rash

Urticarial vasculitis

Urticarial vasculitis is defined by histology showing small vessel vasculitis on skin biopsy.

• Urticarial skin lesions persist for longer than 24 hours
• They sting and burn rather than itch
• They leave brown marks or bruises behind as they fade
• They may be accompanied by purpura and other features of cutaneous vasculitis
• It can be a local process, or it can be associated with systemic disease
• It may be accompanied by migratory arthritis, heart disease, lung disease, kidney disease, gastrointestinal symptoms and neurological complications.
• Associations include systemic lupus erythematosus, systemic sclerosis, infections, inflammatory bowel disease, lymphoma and solid organ cancer.

Hypersensitivity vasculitis, cutaneous polyarteritis nodosa and Churg-Strauss syndrome may also present with urticaria-like lesions.

Urticarial vasculitis: urticarial lesions resolve with bruising

Urticarial vasculitis

Urticarial vasculitis

Urticarial vasculitis

Acute febrile neutrophilic dermatosis

Tender urticaria-like plaques may be seen in acute neutrophilic dermatosis (Sweet syndrome). The lesions often blister and may affect mucosal surfaces as well as skin surfaces. They are often seen on the neck but may occur on any site. The plaques enlarge and persist for days to weeks. Sweet syndrome results in fever, malaise, arthralgia, and other systemic symptoms.

Sweet syndrome: urticarial plaques are often blistered

Sweet disease

Sweet disease

Sweet disease

Neutrophilic urticarial dermatosis

Neutrophilic urticarial dermatosis presents with urticarial lesions that are defined by a histological reaction pattern revealing neutrophils lined up between collagen fibres.

• Fever and arthritis may accompany the skin lesions
• Blood tests reveal raised ESR / CRP and neutrophil leucocytosis (raised white cell count)
• Underlying inflammatory conditions such as rheumatoid arthritis are often present
• Unlike acute neutrophilic dermatosis (Sweet syndrome), there is no blistering or mucosal involvement

Neutrophilic urticarial dermatosis in patients with rheumatoid arthritis

Neutrophilic dermatosis associated with rheumatoid arthritis

Neutrophilic dermatosis associated with rheumatoid arthritis

Neutrophilic dermatosis associated with rheumatoid arthritis

Eosinophilic dermatosis of haematological malignancy

Eosinophilic dermatosis of haematological malignancy arises in some forms of leukaemia. The skin lesions may include urticarial plaques.

Autoinflammatory syndromes

The autoinflammatory syndromes are a group of mainly genetic diseases that affect the skin and other organs.

• Urticarial wheals, macules and papules may occur
• Skin lesions are accompanied by fever and joint disease
• Onset is frequently during childhood
• The inflammation involves activation of the cytokine, interleukin IL-1beta

Urticated erythema

An urticated erythema means a rash with raised red patches. This includes many of the conditions described above. When accompanying upper respiratory symptoms, such as a sore throat, fever and malaise, it is often due to the underlying viral infection and is a type of exanthem. An exanthem with flat red patches may also be called toxic erythema.

What is the bee swarm buzzing about? « Republic of Tatarstan

Published: 07.09.2007 0:00

The last day of the past summer turned out to be extremely fine and sunny. We arrived at the apiary of Sickle and Hammer LLC in Vysokogorsky District in the clear afternoon. There was a monotonous hum above the multi-colored cubes of bee hives lined up in three rows under the spreading apple trees.

There is no better place for an apiary: a clearing surrounded by a forest, nearby, a stone’s throw away, is a gurgling spring. Neither harmful car exhausts, nor the noise coming from busy highways – all this the bees can not stand at all.

“You’d better not come close to the hive,” says the farm beekeeper Antonida Nikolaeva. — Bees are especially aggressive at this time — they can sting…

Antonida Stepanovna has been working at the apiary for ten years, and she knows all the manners and habits of the hymenoptera wards. The end of August, the beginning of September is the time of pumping out honey. For beekeepers – the hottest time. Throwing a protective net over her face, Antonida Stepanovna extracts from the open hive, over which bees swarm menacingly, humming, a rectangular frame with honeycombs. The symmetrical hexagons of the cells are filled with a viscous golden mass – it seems that drops of magical solar rain that poured onto the earth last summer froze in them …

The apiary of Sickle and Hammer LLC is small – only seventy bee colonies. On average, up to 20-22 kilograms of honey is obtained from each hive. But what! Honey this year is excellent, as we were able to verify by tasting the magic balm of a summer meadow.

“This year cannot be called particularly honey-bearing,” the hostess says. – The spring cold during the development of the uterus influenced. Nevertheless, we expect to receive up to one and a half tons of honey this season. And this is far from the limit. With the right approach to business, you can get a lot of benefits. The main thing is the proximity of honey crops. Four years ago, when buckwheat was blooming in the neighboring field, the honey yield for the season exceeded two tons.

Antonida carefully removes another frame from the opened hive and passes it to her assistant Tatyana Kostratova. The frames are taken to the warehouse, where they are placed in a shiny cylinder of a centrifuge for pumping. The frames freed from honey are carefully stored until next spring.

– In the past, – says the head of the farm, Anna Andreevna Zakharova, – the demand for “bee products” was huge: we rented honey to shops and restaurants, receiving a considerable profit from its sale. Now we produce honey mainly for our own needs – recently, for example, we celebrated Collective Farmer’s Day, each of the farm veterans received a three-liter jar as a gift.

Today the honey market is filled with private beekeepers and farmers. It was they who became the main participants in the fair-sale “Honey Shores”, organized on the initiative of the State Administration for Beekeeping of the Republic of Tatarstan and held in Kazan in the last days of August. For three days, residents of the capital of the republic had the opportunity to stock up on the “sweet” products of Tatarstan beekeepers for the winter – a total of 10 tons of honey were sold. A wide range of other products of the beekeeping industry was presented at the exhibition, including bee bread and propolis known for its healing properties.

“Every year the interest in beekeeping in the republic is growing,” says Anatoly Ganzov, Deputy General Director of the State Administration for Beekeeping of the Republic. – This is eloquently evidenced by the figures: if in 2002 in all categories of farms, including private and farmsteads, there were up to 168 thousand bee colonies, then over the past five years their number has increased by 20 percent. Last year, the gross volume of honey obtained from the apiaries of Tatarstan exceeded 6,220 tons, of which 2,757 tons of marketable honey were produced. And although this year the expected volumes of honey collection are somewhat less – the difficult weather conditions of the past summer affected – all the same, the republic will not be left without honey. Moreover, this is a product that can be stored and not deteriorate for years.

In the village of Shapshi, Vysokogorsky district, almost every second inhabitant keeps bees. You can watch the life of summer meadow workers for hours.

“I have six beehives in my garden,” says Anna Stepanovna Batyeva, chief economist of the local economy. — Every time I come to visit my bees, I forget about everything in the world…

Indeed, a bee hive is a unique biological society, a kind of small community of winged workers, where each individual has a strictly defined scope of duties. Among the inhabitants of the hive there are worker bees who are exclusively engaged in honey collection, there are also caregiver bees who look after the “younger generation”, and even guard bees that protect the home from strangers – wasps and philant, nicknamed “bee wolf” for its predatory burrow … In a word , almost everything like people.

Around a two-tiered, elegant, blue-painted hive, bees curl with a menacing buzz. What is the bee hive buzzing about? Probably, that the cold will come very soon and its small hard-working inhabitants should prepare for wintering. ..

We were leaving the apiary in the early fine evening. Outside the windows of the car, the crimson sunset slowly burned out, and in the air there was a continuous rumble of the tireless workers of the summer meadow.

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News of Tatarstan. The heirs of the sweet dynasty

December 5, 2014

Everyone knows the Zaripov brothers in the village of Malaya Elga, Laishevsky district. And how not to know the family of hereditary beekeepers in the fifth generation? After all, their ancestors began to engage in beekeeping more than a century ago – back in the middle of the century before last.

– In 1860, my great-grandfather Mezhit-babai was the first in the village to set up three beehives in his garden, – says the head of the peasant farm Gafur Zaripov. – Before him, no one kept bees in Malaya Elga. The first summer was successful for the novice beekeeper – the honey flow turned out to be notable, and soon the number of hives at the first Malo-Elga beekeeper increased to thirty. They needed a place to keep them, and Mezhit-babay moved the beehives to the forest near our village…

FROM FATHER TO SON

Decades have passed since then, but even today many of the locals call the flattering glade, where the first apiary was once located, “Mezhit kileg” – in memory of the first beekeeper in these places.

Mezhit-babai wanted to pass on the secrets of the honey trade to his sons, but only one of them, Zarif, continued the work of his father. Later, he gave the apiary to his sons – both Zakir and Bahau, and from the latter it was inherited by Burkhan Zaripov, Gafur’s father.

– From the age of twenty, my father worked at the beekeeper of the Pobeda collective farm, Gafur recalls. – He often told how in those years bees were brought to our apiary on carts from other villages. All residents in the area knew that the most fragrant honey can only be found in our village. When he got married, our parents left the village – they lived and worked away from their native places. However, the father did not forget about his beloved work. His fellow villagers also remembered him. And therefore, when in the early seventies the parents returned to their native village, Burkhan Zaripov, without hesitation, was entrusted with a collective farm beekeeper, which by that time looked very deplorable: almost half of the bees are sick, the hives are affected by pests, yes and there was almost no honey left for the upcoming winter … In addition, winter 1973 years turned out to be extremely harsh: cold and snowy. Of the 160 bee colonies, only sixty hives were able to save by spring …

The apiary was raised by the Zaripovs practically from scratch. They spared no effort or time for recovery. In addition, the hands of the beekeeper, yearning for his beloved work, were helped by the experience and knowledge gained from his father and grandfather. Yes, and Burkhan’s wife, Minnegayan, helped her husband in the bee-keeper in everything. And two years later they were able to bring the number of hives to one hundred and fifty, and by the amount of honey delivered to 19In 1975, the apiary of the Pobeda collective farm took first place in the region, for which the Zaripovs were awarded a medal.

Since then, the portraits of the leading beekeepers Burkhan and Minnegayan Zaripov have constantly adorned the board of honor of the Laishevsky district.

CONTINUED FAMILY TRADITIONS

Many years have passed since then. Much has changed in agriculture. Gone are the collective and state farms, with their honorary red banners and victorious reports, the way of life of the villagers and the system of management itself have changed. In 2005, several farms appeared on the site of the bankrupt collective farm.

One of them, the Zaripov farmstead, was founded by one of the sons of Burkhan and Minnegayan, Gafur, who, by his own admission, has been raving about bees since childhood:

– Since 1984, after the end of the decade, I began to work as an assistant in the apiary. he recalls. – After serving in the army, he entered the Mamadysh Agricultural College to study.

It is superfluous to explain what specialty Gafur chose. The years of study flew by quickly. The experience and practice of working in the apiary were supported by the theory received in the lectures.

“When our collective farm was finished, I took ownership of my land share, demarcating 30 hectares of land, deciding to revive the bee-keeper, where my parents worked all their lives,” Gafur continues his story. – Then the young farmer had to start managing in the same way as his father and mother once started – in fact, from scratch. And then, just in time, help arrived in time – a republican program to support small and medium-sized forms of agribusiness in the countryside began to operate in Tatarstan. On subsidies allocated by the Ministry of Agriculture of the Republic of Tatarstan, Gafur built a new omshanik – a room for wintering bee hives, bought bees in the amount of 30 bee families. The summer of 2005 turned out to be extremely successful for beekeepers: warm and not particularly rainy. Honey crops, with which farmer Zaripov sowed his land, sprouted evenly, so that the bribes from the little workers of the green meadow were not bad. A year later, the number of bee colonies in Zaripov’s apiary doubled. And a year later there were even more of them.

Today, Gafur Zaripov keeps three hundred bee colonies in two apiaries. Every year, five to six tons of excellent fragrant honey is pumped out here, the taste of which will not be forgotten by everyone who has tasted it at least once …

AT THE FARM APIER

A bee family is a small community where each bee performs its own function. In addition to worker bees, there are builder bees, educator bees, and even guard bees in the hive. – a kind of bee “omon”, protecting honey pantries from wasps, hornets and philant, nicknamed the bee “wolf” for its predatory burrows. All this is surprisingly reminiscent of our society. Perhaps that is why many beehives in Gafur Zaripov’s apiary are made in the form of small houses. Others resemble funny little animals or fairy-tale characters – Baba Yaga or a mermaid. You can admire other bee houses for hours. You can’t take your eyes off, how good they are! It is felt that they are made with soul, that the master showed all his imagination and ingenuity in their manufacture. But the main thing, of course, is not the appearance of the hive, but its contents.

I am fascinated looking at the symmetrical cells of honeycombs, from which the magical gift of a summer meadow flows like amber drops. It seems that the sultry July sun of the past summer is reflected in it. The taste is amazing! It is no coincidence that distinguished guests of the International Sabantuy, which took place on Laishev land this year, in the vicinity of the picturesque Belaya Gora, were treated to honey from Zaripov’s apiary. Then the honey chak-chak was tasted not only by the President of the Republic Rustam Minnikhanov, but also by the guests who arrived at the plow festival from Turkey and Egypt, from America, Saudi Arabia and Finland.

The quality of honey from Zaripov’s apiary is eloquently evidenced by honorary diplomas that Gafur Burkhanovich carefully keeps at home, as well as diplomas from the Russian Agricultural Academy and Rosplemobedinenie for a great contribution to the development of beekeeping and agriculture in the republic. At the International Exhibition-Fair “Agrorus”, which took place in August this year, Gafur Zaripov’s farm was awarded the gold medal of the Ministry of Agriculture of the Russian Federation in the nomination “Best Family Farm”. The title of Honored Worker of Agriculture of the Republic of Tatarstan Gafur Burkhanovich was awarded two years earlier – in June 2012.

By the way, the Zaripovs’ farming economy lives not only on honey alone. Today, the head of the peasant farm owns and leases more than three hundred hectares of arable land, on which grain crops and “perennial” for cattle are grown. In addition to honey, farmer Zaripov is fattening bulls for meat – there are thirty of them on the farmstead today. But the main thing in the Zaripov farm is, of course, honey.

What are the secrets of high sweet “yields”?

– In order to achieve a good honey flow, we sow honey crops near the apiary for two or three terms, – says Gafur. – We usually sow phacelia and a bruise – bees fly on them. It is even better when there are natural honey plants near the apiary – linden and forest flowers.

Much depends on the breed of bees. Many of our beekeepers have recently been importing bees of the Caucasian breed, claiming that they are more efficient and productive. However, the “Caucasians”, as true southerners, endure our harsh winters badly, during the winter many of them die. In addition, they are seen in the fact that they often steal honey from neighboring hives. I have Central Russian bees of the Tatar population in my apiary. With proper care for them, you can achieve good results and maximum returns, and even in a bad year for a beekeeper, be with honey …

Unfortunately, with all the variety of choices on the market today, it is difficult to find high quality honey. Many unscrupulous dealers, taking advantage of the gullibility of the buyer, can slip him low-quality honey. Therefore, when buying a sweet product, you need to be especially careful.