Dermatitis Herpetiformis Treatment
Treatment with sulfones such as dapsone or sulfapyridine provide dramatic relief from the symptoms of dermatitis herpetiformis within hours to a few days of treatment initiation. In fact, dramatic improvement following the administration of these medications can be used to support the diagnosis of this disorder. Both drugs control, but do not cure the disease. Dapsone is the first choice of the two as it tends to be more effective.
In addition, strict adherence to a gluten-free diet for at least 6 months will improve the intestinal and the skin lesions and will allow most patients to begin a decrease in sulfone therapy. However, the diet has to be followed for many months (often 2 years) before medications can be discontinued. Symptoms and lesions may recur in 1 to 3 weeks if a normal diet is resumed. Current evidence indicates that a gluten-free diet needs to be continued indefinitely and that it may be protective against gastrointestinal lymphomas. However, this diet is often difficult to sustain for long periods of time.
An elemental diet (a diet without full proteins composed of free amino acids, carbohydrates, and small amounts of fats) may also provide significant improvement in skin disease activity, independent of gluten administration. However, similar to the gluten-free diet, an elemental diet is often difficult to maintain.