Collin Pekka, Reunala Timo
Departments of Medicine and Dermatology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland.
Am J Clin Dermatol. 2003;4(1):13-20. doi: 10.2165/00128071-200304010-00002.
In celiac disease, the ingestion of gluten-containing cereals, such as wheat, rye, and barley, results in small-bowel mucosal inflammation and villous atrophy with crypt hyperplasia. The prevalence of the condition may be as high as 1% in the adult population. The disease can also embrace various extraintestinal manifestations, of which dermatitis herpetiformis is the best known. Earlier, dermatitis herpetiformis was considered a skin disease occurring often concomitantly with celiac disease. At present, a body of evidence shows that dermatitis herpetiformis is a cutaneous manifestation of celiac disease, and affects approximately 25% of patients with celiac disease. Both conditions can appear in the same family and are closely linked to HLA class II locus in chromosome 6; 90% of patients have HLA DQ2 and, almost all the remainder, HLA DQ8. All patients with dermatitis herpetiformis have at least some-degree of mucosal inflammation or lesion consistent with celiac disease. The etiology of celiac disease in not fully understood, but tissue transglutaminase seems to be the predominant autoantigen both in the intestine and the skin. Serum antibodies against tissue transglutaminase can be used in the serologic screening and follow-up of dietary compliance of patients with celiac disease. Gluten-free diet is essential in the treatment of both conditions, and oral dapsone is usually needed in newly detected dermatitis herpetiformis in order to alleviate symptoms. Oral mucosal lesions, alopecia areata, and vitiligo probably occur more frequently in patients with dermatitis herpetiformis than in the general population. By contrast, the reported association of celiac disease with psoriasis seems to be coincidental.
在乳糜泻中，摄入含麸质谷物，如小麦、黑麦和大麦，会导致小肠黏膜炎症、绒毛萎缩以及隐窝增生。该病在成年人群中的患病率可能高达1%。这种疾病还可伴有各种肠外表现，其中疱疹样皮炎最为人熟知。早些时候，疱疹样皮炎被认为是一种常与乳糜泻同时发生的皮肤病。目前，大量证据表明疱疹样皮炎是乳糜泻的一种皮肤表现，约25%的乳糜泻患者会出现该症状。这两种疾病可出现在同一家族中，且都与6号染色体上的HLA II类基因座密切相关；90%的患者有HLA DQ2，几乎所有其余患者有HLA DQ8。所有疱疹样皮炎患者都至少有一定程度的黏膜炎症或与乳糜泻相符的病变。乳糜泻的病因尚未完全明确，但组织转谷氨酰胺酶似乎是肠道和皮肤中的主要自身抗原。抗组织转谷氨酰胺酶血清抗体可用于乳糜泻患者的血清学筛查及饮食依从性的随访。无麸质饮食对这两种疾病的治疗都至关重要，新发现的疱疹样皮炎患者通常需要口服氨苯砜来缓解症状。口腔黏膜病变、斑秃和白癜风在疱疹样皮炎患者中可能比普通人群中更常见。相比之下，乳糜泻与银屑病之间的关联似乎是偶然的。
