Female Patients with Dermatitis Herpetiformis Show a Reduced Diagnostic Delay and Have Higher Sensitivity Rates at Autoantibody Testing for Celiac Disease

Abstract

Objective. Our objective was to characterize the demographic information, clinical features, and laboratory data of patients with dermatitis herpetiformis (DH). Methods. In this multicentre cross-sectional study, consecutive patients with a new diagnosis of DH that referred to nine di erent Italian centers between 2011 and 2016 were characterized assessing demographic, clinical and laboratory ndings, and evaluating gender and age di erences across selected variables. Results. A total of 151 patients were included. Among them, 81 (53.6%) were males and 70 (46.4%) were females, with a male to female ratio of 1.2 : 1. e median age at the time of diagnosis was 41 years (range 0-85). Males had a signi cant longer diagnostic delay if compared to females (9 vs. 3 months, respectively; = 0.01). Direct immuno uorescence was positive in 94.7% of the patients, while duodenal biopsy showed partial to total villous atrophy in 70.1% of patients. All the females resulted positive to at least one of the antibodies tested, while a total of 12 male patients (10.5%) tested negative to celiac-speci c antibodies. Female patients had a high rate (14.1%) of autoimmune thyroiditis. Conclusions. Our study con rmed some of the most relevant data regarding DH that have been previously reported in the literature. In addition, we found a reduced diagnostic delay in females with respect to males, possibly related to the higher sensitivity of serologic testing in females with DH compared to males. Finally, we demonstrated that intestinal involvement could be severe in patients with DH and that females should be tested for thyroiditis.

Sex-differences in Gluten-free Dietary Adherence and Clinical Symptoms in Patients with Long-term Treated Dermatitis Herpetiformis

“…There have been only a few studies addressing the differences between males and females affected by DH, and the main focus has been on newly diagnosed patients. Previous studies have linked male sex with younger age at the onset of DH symptoms, more severe skin symptoms at diagnosis and more frequent initiation of dapsone after diagnosis ( 28 – 30 ). Furthermore, 2 studies have shown an increased risk for delayed diagnosis in females ( 21 , 29 ), but, in contrast, 1 study associated increased diagnostic delay with male sex ( 30 ).…”

How Medically Favorable Is the Replacement of the Invasive Colonoscopy With Cologuard Non-Invasive Colorectal Cancer Screening?

“…A prime example of this is found in a peer-reviewed study that analyzed the sensitivity rates of autoantibody testing for celiac disease for the two sexes. 17 For the data collection of the results of the colonoscopies corresponding with the positive Cologuard tests, a medical record database was used to find a sample. Permission was granted by a northeast Ohio local hospital to find all of its positive Cologuard results within the last three years in order to target an initial sample of at least 100 participants.…”

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

“…20 Several studies investigated anti-deamidated gliadin antibodies in DH showing that they have in general a slightly higher sensitivity and a slightly lower specificity than anti-TG2 antibodies in patients with DH. [74][75][76][77][78][79] Thus, detection of antibodies against deamidated gliadin may be considered in the diagnostic workup for DH, but such assays are not recommended as primary tests.…”