Dermatitis herpetiformis in China: a report of 22 cases

Abstract

Although dermatitis herpetiformis (DH) is a relatively common disease in Caucasian populations, it is very rare in the Far East, including China. To investigate the clinical, histological and immunopathological characteristics of Chinese patients with DH. The clinical data and serum samples of patients with DH diagnosed at Shandong Provincial Institute of Dermatology and Venereology from 2006 to 2010 were collected. Anti-endomysium antibodies (EMA) and anti-tissue transglutaminase (tTG) antibodies were tested using indirect immunofluorescence and enzyme-linked immunosorbent assay respectively. Biopsies of small intestine were performed in those patients who had given informed consent. The study group consisted of 22 patients with DH. The male to female ratio was 2.1:1; the average age was 44 years. Five patients reported mild gastrointestinal symptoms. Dapsone was used to treat 14 patients, who achieved rapid relief. Direct immunofluorescence showed granular IgA deposits at the papillary tips and/or basement membrane zone in 95.5% (21/22) patients. Fibrillar IgA deposition limited to the papillary tips was also seen in one patient (4.5%). IgA antibodies against EMA and tTG were found in 50% (8/16) and 62.5% (10/16) of patient sera respectively. Small-intestinal biopsies of two patients confirmed the presence of coeliac disease. The clinical, histological and immunopathological characteristics of Chinese patients with DH are similar to those seen in Caucasian populations. The positive rates of anti-EMA and anti-tTG antibodies were lower compared with those seen in Western countries. DH is not extremely rare in China and should be actively investigated.