Dermatitis Herpetiformis Refractory to Gluten-free Dietary Treatment

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http://hdl.handle.net/10138/160248

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Hervonen , K , Salmi , T T , Ilus , T , Paasikivi , K , Vornanen , M , Laurila , K , Lindfors , K , Viiri , K , Saavalainen , P , Collin , P , Kaukinen , K & Reunala , T 2016 , ' Dermatitis Herpetiformis Refractory to Gluten-free Dietary Treatment ' , Acta Dermato-Venereologica , vol. 96 , no. 1 , pp. 82-86 . https://doi.org/10.2340/00015555-2184

Title: Dermatitis Herpetiformis Refractory to Gluten-free Dietary Treatment
Author: Hervonen, Kaisa; Salmi, Teea T.; Ilus, Tuire; Paasikivi, Kaija; Vornanen, Martine; Laurila, Kaija; Lindfors, Katri; Viiri, Keijo; Saavalainen, Paivi; Collin, Pekka; Kaukinen, Katri; Reunala, Timo
Contributor: University of Helsinki, Research Programs Unit
Date: 2016
Language: eng
Number of pages: 5
Belongs to series: Acta Dermato-Venereologica
ISSN: 0001-5555
URI: http://hdl.handle.net/10138/160248
Abstract: Dermatitis herpetiformis (DH) is a blistering skin disease, which is regarded as an extra-intestinal manifestation of coeliac disease. Refractory cases of coeliac disease, that do not respond to a gluten-free diet and which carry an increased risk of lymphoma, are well-known in coeliac disease. To determine whether refractory cases of DH with active rash and persistent small bowel atrophy occur we analysed our series of 403 patients with DH. Seven (1.7%) patients, who had been on a gluten-free diet for a mean of 16 years, but who still required dapsone to treat the symptoms of DH, were identified. Of these, one patient died from mucinous adenocarcinoma before re-examination. At re-examination skin immunoglobulin A (IgA) deposits were found in 5/6 refractory and 3/16 control DH patients with good dietary response. Small bowel mucosa was studied at re-examination from 5 refractory and 8 control DH patients and was normal in all 5 refractory and 7/8 control DH patients. One refractory DH patient died from adenocarcinoma, but no lymphoma developed in any of the patients. This study documents for the first time refractory DH, in which the rash is non-responsive to a gluten-free diet, but the small bowel mucosa heals. This differs from refractory coeliac disease, in which the small bowel mucosa does not heal on a gluten-free diet.
Subject: dermatitis herpetiformis
coeliac disease
small bowel mucosa
gluten-free diet
dapsone
CELIAC-DISEASE
SKIN-LESIONS
LYMPHOCYTES
WITHDRAWAL
LYMPHOMA
IGA
3121 General medicine, internal medicine and other clinical medicine
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