Dermatitis Herpetiformis with Coeliac Disease: A Case Report of Improvement in Pruritic Cutaneous Manifestations Following Individualised Homoeopathic Management

Abstract

Background: Dermatitis herpetiformis (DH) is a chronic, intensely pruritic cutaneous condition associated with gluten sensitivity and coeliac disease. The clinical presentation may be recurrent and may be influenced by dietary and environmental triggers. This case describes a patient with a five-year history of recurrent pruritic eruptions with seasonal aggravation and subsequent documentation of coeliac disease.

Case Presentation: The patient presented with recurrent skin eruptions and marked itching for approximately five years. Symptoms were aggravated by seasonal changes, heat, exposure to water and wearing polyester clothing. The affected areas included bilateral upper and lower limbs, including the hands and feet. The patient had been using anti-allergic medication, including cetirizine, for symptomatic relief. A significant personal history included being a national swimmer who had to discontinue swimming at approximately 16 years of age following a kidney problem requiring stent surgery, which was described as a major source of stress. The patient was also receiving treatment for bipolar disorder. During subsequent hospitalisation for behavioural changes, the discharge documentation recorded bipolar disorder, hypothyroidism, type 2 diabetes mellitus and coeliac disease. During follow-up, the skin complaints and itching improved. A recurrence of eruptions was specifically reported after consumption of gluten and subsequently settled after cetirizine.

Homoeopathic Management: The case was individualised based on the recorded mental and general characteristics. Sulphur was documented as the constitutional prescription, based on the recorded philosophical disposition and craving for sweets, with a psoric interpretation in the case record. The exact potency, dosage and repetition were not available in the supplied case data.

Outcome: Progressive improvement in itching and skin eruptions was documented during follow-up. The gluten-associated recurrence provided an important clinical observation consistent with the subsequently documented diagnosis of coeliac disease.

Conclusion: This case highlights the importance of detailed history taking, identification of dietary triggers and consideration of associated systemic conditions in patients presenting with chronic recurrent pruritic eruptions. The observed improvement following individualised management warrants further systematic investigation, while this single case cannot establish treatment efficacy or causation.