Dermatitis herpetiformis.
Study Goal
The researchers aimed to evaluate the effectiveness of a gluten-free diet (GFD) in treating dermatitis herpetiformis (DH) and its associated small bowel mucosal damage, as well as its impact on quality of life and lymphoma risk.
Results Summary
The study found that a strict, lifelong GFD effectively alleviates DH symptoms, heals small bowel mucosal damage, improves quality of life, and reduces lymphoma risk. However, GFD has a slow effect on the DH rash, necessitating additional treatment with dapsone for severe cases.
Population
Adults diagnosed with dermatitis herpetiformis (DH), slightly more common in males.
Effective Dosage
Not specified
Duration
Lifelong adherence
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
strict, life-long adherence to a gluten-free diet (GFD) | decrease | the symptoms of DH | patients with DH | - | alleviating | #1 |
strict, life-long adherence to a gluten-free diet (GFD) | decrease | the small bowel mucosal damage | patients with DH | - | healing | #2 |
strict, life-long adherence to a gluten-free diet (GFD) | increase | the quality of life | patients with DH | - | increases | #3 |
strict, life-long adherence to a gluten-free diet (GFD) | decrease | the risk for lymphoma | patients with DH | - | decreases | #4 |
strict, life-long adherence to a gluten-free diet (GFD) | decrease | the mortality rate | patients with DH | - | seems to be lower | #5 |
dapsone medication | decrease | severe skin symptoms | patients with DH | - | treated | #6 |
Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease (CD), which causes an itching and blistering rash, typically on the elbows, knees and buttocks. DH and CD share a similar genetic background, small bowel mucosal alterations, and an autoimmune response against tissue transglutaminase in the serum and small bowel. DH is typically diagnosed during adulthood, and it is slightly more common among males than females. The incidence of DH seems to be decreasing, in contrast to the detected four-fold increase in the incidence of CD. In addition to typical clinical picture, diagnosis of DH relies on the demonstration by direct immunofluorescence of pathognomonic granular IgA deposits in the papillary dermis. Circulating tissue transglutaminase antibodies support the diagnosis, but their absence does not exclude DH. Obtainment of small bowel mucosal biopsies is not necessary when DH is diagnosed, but if performed, the majority of patients are found to have villous atrophy, and even those with normal villous architecture evince CD-type inflammation. The treatment of choice in DH is a strict, life-long adherence to a gluten-free diet (GFD). In addition to alleviating the symptoms of DH and healing the small bowel mucosal damage, a GFD increases the quality of life for patients, and decreases the risk for lymphoma in DH. Further, the mortality rate of patients with DH treated with a GFD seems to be lower than that of the general population. However, as changing to a GFD has a rather slow effect on the DH rash, patients with severe skin symptoms should additionally be treated with dapsone medication. This review article is based on a presentation given at the British Society for Medical Dermatology blistering skin diseases meeting 2019.