Long term follow-up of dermatitis herpetiformis with and without dietary gluten withdrawal

Abstract

Seventy-eight patients with dermatitis herpetiformis have been followed up for periods ranging from 3 to 14 years (mean 7.4). Forty-two patients were treated with gluten-free diet (GFD) and thirty-six took a normal diet (ND). Thirty of the forty-two (71%) taking the GFD were able to discontinue drugs previously needed to control their rash compared with five (14%) of the thirty-six patients taking a ND. The mean time taken to reduce drug requirements for patients taking a GFD was 8 months (range 4-30), and for stopping drugs, 29 months (range 6-108). The incidence of macroscopic abnormality of the small intestine decreased from 69 to 15%, and the mean intra-epithelial lymphocyte count decreased significantly in those patients taking a GFD, whereas there was no significant change in patients taking a ND. The improvement in the skin and intestinal lesions was related to the strictness of the GFD.

Natural History of Dermatitis herpetiformis in Southern Sweden

“…Moi [13] also found several mild cases of DH in his material. The connection between DH and celiac disease, primarily reported by Marks et al [27], and the beneficial effect of a gluten-free diet is well documented [28][29][30]. However, our results as well as Moi's [13] indicate that the gluten-free diet regimen should be pre scribed only in clinically more active cases of DH.…”

Clinical Aspects of Adult Celiac Disease - An Overview

“…Some further categories seem to coincide with celiac disease for other rea sons. The skin rash in dermatitis herpetiformis is the classical example of a gluten-sensitive affection outside the gastrointestinal tract [21]. The dietary response may vary, but in most studies, about half the patients starting the gluten-free diet can successfully discon tinue their drug therapy within 2-3 years, always preceded by improvement of the jeju nal mucosal damage.…”

Comment on “Dermatitis Herpetiformis Sera or Goat Anti–Transglutaminase-3 Transferred to Human Skin-Grafted Mice Mimics Dermatitis Herpetiformis Immunopathology”

“…This finding agrees with a large body of data showing that dermal IgA deposition is necessary, but not sufficient, for DH. These data include the Cannistraci report, as well as that of Fry et al (8), that IgA persists years beyond clinical resolution in patients on a gluten-free diet; that IgA is present in nonlesional skin, which is our work (9); and that lesions resolve acutely with an elemental diet (10). Although not addressed in the article under discussion, we believe that intestinal inflammation driven by gluten as well as local cutaneous factors is important in the development of lesions.…”