Chapter 9

Itching to be diagnosed

  • (Age: 66 years, male)

    My symptoms began almost two years ago with a breakout of small, very itchy spots along the crease of my buttocks that did not respond to any over-the-counter creams or ointments.

    After exhausting all available options I visited my family doctor.

    His diagnosis was poison ivy, even though I was quite clear that there was no way that was possible. However, being desperate by that time, I applied the prescribed ointment with no results.

    Subsequent visits over several months, many different prescriptions, and a modified diagnosis of poison oak, proved equally ineffective.

    I was then referred to a specialist in dermatology in …….., Ontario.

    A biopsy indicated dermatitis herpetiformis.

    As I am allergic to sulfa medications, I was prescribed Dapsone 100 mg along with a topical ointment Elocom 0.1%. Trial and error over several months, and countless blood tests, reduced the dosage to half tablet every three days.

    I am now balanced and doing well, except for the occasional unexpected bout with foods containing gluten.

    From the initial incorrect diagnosis, to the biopsy results taken by the specialist, was about 12 months.

    In light of subsequent knowledge of my condition, I do not blame my doctor. He was only working with the training that he had received.

    We have both learned the insidiousness of this problem.


  • Clinical Pearls

    Dermatitis herpetiformis (DH) is “celiac disease of the skin”.

    All that itches is not eczema. If a chronic, severely itchy, blistering rash does not respond to conventional therapy, think DH.

  • A skin biopsy will help make the diagnosis of DH and a gluten-free diet will help alleviate the suffering.

Copyright © 2007 by Mohsin Rashid
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