A retrospective study of dermatitis herpetiformis from an immunobullous disease clinic in north India

Handa, Sanjeev; Dabas, Garima; De, Dipankar; Mahajan, Rahul; Chatterjee, Debajyoti; Saika, Uma N.; Radotra, Bishan Dass

doi:10.1111/ijd.14029

Cited by 9 publications

(13 citation statements)

References 19 publications

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“…The prevalence of prolonged skin symptoms in this study is rather high compared with our more recent study, in which only 13% of patients with DH were using dapsone after 2 years of adherence to a GFD ( 33 ). However, the few recent studies from other countries have reported that, despite strict adherence to a GFD, the majority of patients have been unable to stop dapsone during the first 2 years after diagnosis of DH ( 4 , 32 ), giving even a higher prevalence of prolonged skin symptoms than in the current study.…”

Section: Discussioncontrasting

confidence: 63%

“…Contemporary data concerning the duration of skin symptoms in DH after diagnosis and the onset of a GFD is scarce, and the few recent studies covering the subject have produced conflicting results ( 4 , 31 , 32 ). In the current study, 38% of patients with DH had skin symptoms enduring longer than 2 years after diagnosis and, among them, the majority (64 out of 69) were using dapsone longer than 2 years after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-free Diet in Dermatitis Herpetiformis

Pasternack

Hervonen²,

Mansikka³

et al. 2021

Acta Derm Venereol

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Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a gluten-free diet. However, the itching and blistering rash alleviates slowly after gluten withdrawal and occasionally persists despite a long-term gluten-free diet. This study investigated the prevalence and factors associated with prolonged (i.e. > 2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of gluten-free diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-free Diet in Dermatitis Herpetiformis

Pasternack

Hervonen²,

Mansikka³

et al. 2021

Acta Derm Venereol

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“…Cutaneous lesions tend to heal without scarring, although post‐inflammatory hyper‐, or hypopigmentation may occur. In patients with darker skin types, the clinical presentation is similar to that seen in Caucasians 15,33 …”

Section: Diagnosticsmentioning

confidence: 72%

S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV)

Görög

Antiga

Caproni

et al. 2021

Acad Dermatol Venereol

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Introduction Dermatitis herpetiformis (DH) is a chronic, pruritic, gluten‐induced skin disorder characterized by subepidermal granular IgA deposition and a variable degree of enteropathy identical to that seen in coeliac disease. So far, there has been no European consensus about the management of DH. Methods The guidelines were created by small subgroups of a guideline committee consisting of 26 specialists from various medical fields and one patients’ representative. The members of the committee then discussed the guidelines and voted for the final version at two consensus meetings. The guidelines were developed under the support of the European Academy of Dermatology and Venereology (EADV) and in collaboration with the European Dermatology Forum (EDF). Results The guidelines summarize evidence‐based and expert‐based recommendations (S2 level) for the management of DH (see Appendix). Conclusion These guidelines will improve the quality of management of DH and support dermatologists in their diagnostic and therapeutic decisions.

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“…DH is now known to be a common extraintestinal manifestation of celiac disease occurring in up to 10% of the celiac disease patient series in Europe and North America [13][14][15]. Small DH series have also recently been described in Brazil, China, and India [16][17][18]. The incidence of DH has been shown to be decreasing [19,20], whereas the opposite is true for celiac disease, most likely because of improved awareness of subclinical cases and the wide use of serologic screening [21].…”

Section: Dermatitis Herpetiformis Linked To Celiac Diseasementioning

confidence: 99%

Dermatitis Herpetiformis: An Update on Diagnosis and Management

2021

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Dermatitis herpetiformis (DH), presenting with an intense itch and blistering symmetrical rash, typically on the elbows, knees, and buttocks, is a cutaneous manifestation of celiac disease. Though overt gastrointestinal symptoms are rare, threefourths of patients with DH have villous atrophy in the small bowel, and the rest have celiac-type inflammatory changes. DH affects mostly adults and slightly more males than females. The mean age at onset is about 50 years. DH diagnosis is confirmed by showing granular immunoglobulin A deposits in the papillary dermis. The DH autoantigen, transglutaminase 3, is deposited at the same site in tightly bound immune complexes. At present, the DH-to-celiac disease prevalence is 1:8. The incidence of DH is decreasing, whereas that of celiac disease is increasing, probably because of improved diagnostics. In DH, the treatment of choice for all patients is a gluten-free diet (GFD) in which uncontaminated oats are allowed. At onset, most patients need additional dapsone to rapidly control the rash and itching. Dapsone can be stopped after a mean of 2 years, and a strict lifelong GFD alone is required. Dietary adherence offers an excellent long-term prognosis for patients with DH, with a normal quality of life and all-cause mortality.

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A retrospective study of dermatitis herpetiformis from an immunobullous disease clinic in north India

Cited by 9 publications

References 19 publications

Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-free Diet in Dermatitis Herpetiformis

Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-free Diet in Dermatitis Herpetiformis

S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV)

Dermatitis Herpetiformis: An Update on Diagnosis and Management

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