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Discrete palmar and plantar symptoms in children with dermatitis herpetiformis Duhring
Insights
Dermatitis herpetiformis in children can present with unusual hand and foot symptoms. These skin lesions, often small spots or blisters, were observed in most affected children and resolved with treatment.
Area of Science:
- Dermatology
- Pediatric Dermatology
- Gastroenterology
Background:
- Dermatitis herpetiformis (DH) is a chronic, intensely itchy skin rash associated with celiac disease.
- While typically presenting on extensor surfaces, DH can manifest with varied cutaneous symptoms.
Purpose of the Study:
- To describe unusual palmar and plantar (hand and foot) symptoms in children diagnosed with dermatitis herpetiformis.
- To correlate these symptoms with diagnostic markers and treatment responses.
Main Methods:
- Observation of 47 children diagnosed with dermatitis herpetiformis.
- Skin biopsy to confirm granular IgA deposits.
- Jejunal biopsy to assess for villous atrophy.
- Clinical monitoring of skin lesions during treatment.
Main Results:
- Thirty of forty-seven children exhibited discrete palmar and/or plantar symptoms, including small spots or blisters.
- Granular IgA deposits in skin confirmed DH diagnosis in all cases.
- Forty-five children showed jejunal villous atrophy, indicating associated celiac disease.
- Palmar symptoms were more common than plantar symptoms and resolved with treatment.
Conclusions:
- Palmar and plantar lesions are an under-recognized manifestation of dermatitis herpetiformis in children.
- These symptoms appear to be linked to active disease and resolve with appropriate treatment, such as a gluten-free diet or medication.
Abstract:
Unusual, discrete palmar and plantar symptoms observed in thirty of forty-seven children with dermatitis herpetiformis are described. The diagnosis was verified in every case by the demonstration of granular IgA deposits in the skin. Forty-five of the children showed villous atrophy in jejunal biopsy specimens. In four cases extensive, exudative, bullous palmar symptoms, similar mild plantar changes, and healing with desquamation were observed. At least once during treatment we found very discrete, reddish-brown spots or small blisters on the flexor surface of the fingers and on the palms in thirty patients. Similar lesions occurred on the soles and plantar surface of the toes in only three patients. In asymptomatic patients and those treated with either a gluten-free diet or sulfone/sulfapyridine, the phenomenon was not manifest.