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Dermatitis herpetiformis.

Clinical and experimental dermatology
October 1, 2019
T T Salmi
Journal ArticleReviewHuman Study
Study Details

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

Extracted Claims (6)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
Celiac DiseaseDermatitis HerpetiformisDiet, Gluten-FreeHumansPrognosis
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality75/10
Citation Metrics
Total Citations28
Citations/Year4.7
Relative Citation Ratio2.00
NIH Percentile74.6%
Research Impact Scores
APT Score0.75
Weight Score2.24
Normalized Score0.69
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