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Nutrients. 2018 May 12;10(5). pii: E602. doi: 10.3390/nu10050602.

Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease.

Author information

1
Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, 33014 Tampere, Finland. timo.reunala@uta.fi.
2
Department of Dermatology, Tampere University Hospital, 33521 Tampere, Finland. timo.reunala@uta.fi.
3
Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, 33014 Tampere, Finland. teea.salmi@staff.uta.fi.
4
Department of Dermatology, Tampere University Hospital, 33521 Tampere, Finland. teea.salmi@staff.uta.fi.
5
Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, 33014 Tampere, Finland. kaisa.hervonen@staff.uta.fi.
6
Department of Dermatology, Tampere University Hospital, 33521 Tampere, Finland. kaisa.hervonen@staff.uta.fi.
7
Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, 33014 Tampere, Finland. katri.kaukinen@staff.uta.fi.
8
Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland. katri.kaukinen@staff.uta.fi.
9
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33521 Tampere, Finland. pekka.collin@uta.fi.

Abstract

Dermatitis herpetiformis (DH) is a common extraintestinal manifestation of coeliac disease presenting with itchy papules and vesicles on the elbows, knees, and buttocks. Overt gastrointestinal symptoms are rare. Diagnosis of DH is easily confirmed by immunofluorescence biopsy showing pathognomonic granular immunoglobulin A (IgA) deposits in the papillary dermis. A valid hypothesis for the immunopathogenesis of DH is that it starts from latent or manifest coeliac disease in the gut and evolves into an immune complex deposition of high avidity IgA epidermal transglutaminase (TG3) antibodies, together with the TG3 enzyme, in the papillary dermis. The mean age at DH diagnosis has increased significantly in recent decades and presently is 40⁻50 years. The DH to coeliac disease prevalence ratio is 1:8 in Finland and the United Kingdom (U.K.). The annual DH incidence rate, currently 2.7 per 100,000 in Finland and 0.8 per 100,000 in the U.K., is decreasing, whereas the reverse is true for coeliac disease. The long-term prognosis of DH patients on a gluten-free diet is excellent, with the mortality rate being even lower than for the general population.

KEYWORDS:

coeliac disease; dermatitis herpetiformis; epidermal transglutaminase; gluten-free diet; long-term prognosis; prevalence

PMID:
29757210
PMCID:
PMC5986482
DOI:
10.3390/nu10050602
[Indexed for MEDLINE]
Free PMC Article

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