Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide

Abstract

We report a patient with severe dermatitis herpetiformis (DH) who was intolerant of dapsone, sulphapyridine, systemic steroids, and azathioprine. He was treated effectively with a combination of heparin, tetracycline and nicotinamide.

Decreased fibrinolytic potential and morphological changes of fibrin structure in dermatitis herpetiformis

“…Such serum clots from DH patients did not differ in their fibrinolytic properties from clots of This is a preprint version of the paper published in J Dermatol Sci. 2016 Oct;84 (1) Thus, the impaired fibrinolytic potential and the modified fibrin structure were associated and could contribute to DH skin lesion initiation, supporting earlier data that suggested the role of haemostatic imbalance in cutaneous symptoms and highlighted the therapeutic effect of anticoagulation [ [20], [21], [22], [24]]. An established therapeutic modality in DH is dapsone administration.…”

“…DH skin lesions had been initiated in vivo by autologous serum injection, but this reaction did not develop in response to plasma treated with heparin or an antifibrinolytic agent (-aminocaproic acid) [21]. Some reports evidence the efficiency of heparin in the treatment of severe DH patients, who did not tolerate sulfones [ [22], [23], [24]], but the exact mechanism behind this therapeutic effect has not been fully explored.…”

Management of autoimmune bullous diseases: Pharmacology and therapeutics

“…Patients with intolerance of or allergy to dapsone and sulfapyridine may be given colchicines, 166 cholestyramine, 167 heparin, tetracycline, and nicotinamide. 168 These agents, however, are much less effective than dapsone and sulfapyridine. Topical steroids are only minimally effective.…”

Dermatitis herpetiformis

“…In uncontrolled studies and case reports, cyclosporine, colchicine, heparin, tetracycline, and nicotinamide have all been claimed to be effective in patients with DH. [44][45][46][47][48][49] Antihistamines may play a limited, adjunctive role to control DH-associated pruritus. 1 The care of patients with DH should involve a team approach that includes a dermatologist, gastroenterologist, and nutritionist.…”