Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is an intensely itchy, Low Dose Naltrexone, chronic dermatological condition manifested by blistering skin because of gluten-sensitive enteropathy, generally known as celiac disease. DH is the type of rash that affects almost 10% of people having celiac disease. DH mainly occurs in adults and happens to be more prevalent in men. People of northern European descent, mostly get this disease, and it is rarely found in Asian Americans and African Americans.

Symptoms

Dermatitis herpetiformis is identified by tiny, clustered bumps and blisters that break out symmetrically on the elbows, buttocks, knees, back, or scalp. These blisters can also appear on the face and groin. A burning sensation might precede lesion development. Lesions often get scratched off by the patient until he/she finally gets a physical examination, and the rash might appear as excoriations and erosions.

People with DH might also undergo dental enamel issues with permanent teeth, and it is another indication of celiac disease. Fewer than 20% of patients with dermatitis herpetiformis experience symptoms of celiac disease.

Causes

Dermatitis herpetiformis results from the deposition of IgA (immunoglobulin A) in the skin that triggers additional immunologic reactions leading to lesion formation. DH is an externally visible manifestation of an unusual immune response towards gluten, which involves the formation of IgA antibodies against tissue transglutaminase.

Family studies reveal that 5% of first-degree relatives of a DH patient would also have or develop dermatitis herpetiformis. An extra 5% of first-degree relatives of a DH patient will have celiac disease. Many different autoimmune diseases are linked with DH, the most popular being hypothyroidism.

Diagnosis

The initial step in diagnosing DH is a skin biopsy. Direct immunofluorescence of biologically normal skin next to a lesion displays granular IgA deposited in the upper dermis. Histology of skin with lesions might exhibit microabscesses that contain neutrophils and eosinophils. But, histology might reveal just excoriation because of the severe itching that patients undergo.

Blood examinations for anti-tissue or anti-endomysial transglutaminase antibodies might also indicate celiac disease. Blood examinations for epidermal transglutaminase antibodies show positive results in more than 90% of cases. Each of these test results becomes negative by sticking to a gluten-free diet for a long time.

A positive serology and biopsy confirm DH and must be considered as an indirect indication of small bowel damage.

Treatment

The sulfone dapsone can render instant alleviation of symptoms. For patients intolerant to dapsone, sulfamethoxypyridazine or sulfapyridine might be used, but these medicines are less efficient than dapsone. To date, a strict gluten-free regime is the exclusive treatment option for the underlying disease. Along with a gluten-free diet, medicinal therapy might need to be strictly followed for a few months to years.

Dermatitis herpetiformis sometimes goes into remission that is characterized as the disappearance of skin lesions and signs of DH for few years without any medicinal treatment and not sticking to a gluten-free diet. Cohort studies revealing DH remission grant support for decreasing sulfone treatment and weaning from a diet free from gluten in people with well-controlled DH.

Is Low Dose Naltrexone a potential treatment option for Adult-Onset Dermatitis Herpetiformis?

Low Dose Naltrexone (LDN) is being utilized as an immune system regulator, giving relief to sufferers of autoimmune diseases and CNS disorders. Though it is not approved by the FDA, particularly for these diseases, doctors are allowed to prescribe LDN as an ‘off-label’ treatment where they think is appropriate.

The different conditions in which LDN seems to produce a therapeutic effect are joined. By their capacity to benefit from enhanced levels of endorphins, which are the body’s naturally occurring opioids – especially OGF.

In almost 2% of patients, dermatitis herpetiformis appears to be refractory to a gluten-free diet. A patient with the celiac disease having diet refractory dermatitis herpetiformis was given low dose naltrexone as a treatment. Randomized controlled trials proved that the short-acting opioid antagonist (naltrexone) is an efficient treatment option for Crohn’s disease and fibromyalgia. The subject’s skin lesions remained present for two years, and within three months of using naltrexone, they went into complete remission. Researchers theorized that antigens associated with gluten stimulate memory B-lymphocytes responsible for producing autoimmune antibodies, and this might keep dermatitis herpetiformis in existence. Endorphins generated by up-regulation with low dose naltrexone might decrease this B-cell activity.

Role of compounding pharmacies in providing Low Dose Naltrexone

The FDA has not yet approved the use of low-dose naltrexone for any condition other than drug addiction, including opioid abuse and alcoholism. However, in lower doses, this medicine could benefit patients undergoing many complex medical conditions.

Because LDN is not approved by FDA for off-label treatments. The only way to take naltrexone in lower doses is by getting your prescription filled by a compounding pharmacy such as Harbor Compounding Pharmacy. Compounding pharmacies work uniquely from standard pharmacies. They develop or compound drugs intended to meet your particular needs.

For instance, if your doctor prescribed you 2mg of low-dose naltrexone. Services of a compounding pharmacy would be needed to create that particular dose of the medication, as naltrexone is usually available in 50 mg tablets only. Also, if you are incapable of taking tablets orally, different options may be provided to you.

Harbor Compounding Pharmacy

Will able to compound your LDN into eye drops, sublingual drops, topical lotions, creams, or even liquid dosage forms. The price can range, depending on the dosage form of your low-dose naltrexone. You can chat with your compounding pharmacist to decide which one form of administration suits you the best.

As stated, naltrexone in increased doses is categorized as an opioid receptor antagonist. Inhibits the receptors to prevent the effects of medicines like morphine. Higher doses of naltrexone also have been displayed to limit the endorphin release after physical activity. Contrasting to higher doses of naltrexone, Low Dose Naltrexone performs its action on β-endorphin receptors to excite the discharge of endorphins in the body.

Treating pain can be a complex trial but the patient can benefit from an option that involves. Consideration of both physiological and psychological features of a patient’s symptoms. Healthcare providers have various tools at their avail when confronting the challenge of pain management. Managing the symptoms of pain with LDN as a single option of therapy might not always work. But, if the patient’s health situation is very inflammatory (like rheumatoid arthritis) making use of LDN can be greatly helpful in itself.