A rare case of dermatitis herpetiformis requiring parenteral heparin for long-term control

We report a patient with controlled coeliac disease but severe dermatitis herpetiformis who was intolerant of dapsone and sulphapyridine. She ultimately had to be treated with parenteral heparin which brought about involution of the skin lesions with symptomatic relief within 1 week. The mechanism of action of heparin is uncertain but may be related to the inhibition of the formation of proteases generated from polymorphs by the clotting process. The treatment is associated with great difficulties in administration over the long term and associated with the risk of haemorrhage. This case illustrates these problems.