Abstract
Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. At diagnosis, the majority of patients have villous atrophy in the small bowel mucosa. The objective of this study was to investigate whether the presence or absence of villous atrophy at diagnosis affects the long-term prognosis of DH. Data were gathered from the patient records of 352 DH and 248 coeliac disease patients, and follow-up data via questionnaires from 181 DH and 128 coeliac disease patients on a gluten-free diet (GFD). Of the DH patients, 72% had villous atrophy when DH was diagnosed, and these patients were significantly younger at diagnosis compared to those with normal small bowel mucosa (37 vs. 54 years, p < 0.001). Clinical recovery on a GFD did not differ significantly between the DH groups, nor did current adherence to a GFD, the presence of long-term illnesses, coeliac disease-related complications or gastrointestinal symptoms, or quality of life. By contrast, the coeliac disease controls had more often osteopenia/osteoporosis, thyroid diseases, malignancies and current gastrointestinal symptoms compared to the DH patients. In conclusion, villous atrophy at the time of DH diagnosis does not have an impact on the clinical recovery or long-term general health of DH patients.
Highlights
Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease currently affecting approximately 13% of coeliac disease patients [1,2]
The median age at diagnosis was significantly higher in the DH patients with normal villous architecture compared to the DH patients with villous atrophy (p < 0.001, Table 1)
The DH patients with villous atrophy were significantly more often serum coeliac autoantibody-positive compared to the DH patients with normal villous architecture (73% vs. 39%, p < 0.001, Table 1)
Summary
Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease currently affecting approximately 13% of coeliac disease patients [1,2]. Autoantibodies against endogenous enzyme tissue transglutaminase (TG2) are characteristically present in the serum and the intestine in both conditions [6,7,8,9]. Diagnosis of DH is verified with the detection of pathognomonic granular immunoglobulin A (IgA) deposits in the uninvolved skin by direct immunofluorescence (IF) examination [10]. This IgA is known to target epidermal transglutaminase (TG3) [11], which is considered the autoantigen in DH, Nutrients 2018, 10, 641; doi:10.3390/nu10050641 www.mdpi.com/journal/nutrients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
