The Small Intestinal Mucosa in Dermatitis Herpetiformis

Abstract

Proximal intestinal mucosal abnormalities are almost invariably found in dermatitis herpetiformis if a sufficient number of biopsies are taken. Fifteen patients (group 1) had flat lesions near the duodenojejunal junction indistinguishable from those seen in celiac sprue. Six patients (group 2) had lesions in this same area ranging in severity from almost normal to completely flat. Only 1 patient had normal intestinal biopsies (group 3). Sampling of the full length of the small intestine in 5 patients in group 1 showed the lesions to have a similar distribution to that seen in untreated celiac sprue, i.e., improvement toward normal as one proceeded from proximal to distal small bowel. Multiple biopsies of the proximal small bowel in 5 patients in group 2 demonstrated the patchy proximal mucosal involvement seen in some patients with dermatitis herpetiformis. Clinical and laboratory evidence of significant malabsorption was absent in most of the patients and this is best explained by the limited length of small intestine involved in this skin disorder.