Salmi Teea T, Hervonen Kaisa, Kurppa Kalle, Collin Pekka, Kaukinen Katri, Reunala Timo
Department of Dermatology, Tampere University Hospital , Tampere , Finland.
Scand J Gastroenterol. 2015 Apr;50(4):387-92. doi: 10.3109/00365521.2014.974204. Epub 2015 Feb 1.
Dermatitis herpetiformis (DH) is a cutaneous form of celiac disease affecting ∼ 17% of celiac disease patients. The aim was to determine how often celiac disease precedes the development of DH, and what is the impact of gluten-free diet (GFD) in this phenotype change.
Our prospectively collected DH series from 1970 comprised 514 patients. We analyzed all DH patients who at least 2 years earlier had been diagnosed with celiac disease. DH diagnosis was confirmed by showing immunoglobulin A deposits in dermis. Serological and small bowel mucosal findings were analyzed, and the strictness of GFD treatment before and after the diagnosis of DH was evaluated.
Twenty (4%) DH patients had a prior diagnosis of celiac disease. The median time interval between celiac disease and DH detection was 9.5 years. Before DH appeared 4 patients had been on a normal gluten-containing diet, 10 had dietary lapses on a GFD, and 6 were on a strict GFD. Celiac autoantibodies were positive in 7 out of 19 patients, and 5 out of 7 undergoing small bowel biopsy had partial villous atrophy. Following DH diagnosis the rash was controlled after a median of 6 months on a strict GFD.
Patients with celiac disease may develop DH by time. This is most often an indicator of poor adherence to GFD, and a rigorous dietary intervention is necessary. In the majority of cases, DH will be detected without prior celiac disease diagnosis, but the physicians should recognize this phenotype alteration.
疱疹样皮炎（DH）是乳糜泻的一种皮肤表现形式，影响约17%的乳糜泻患者。本研究旨在确定乳糜泻在DH发生之前出现的频率，以及无麸质饮食（GFD）对这种表型变化的影响。
我们前瞻性收集了1970年以来的DH病例系列，共514例患者。我们分析了所有至少在2年前被诊断为乳糜泻的DH患者。通过显示真皮中免疫球蛋白A沉积来确诊DH。分析血清学和小肠黏膜检查结果，并评估DH诊断前后GFD治疗的严格程度。
20例（4%）DH患者之前被诊断为乳糜泻。乳糜泻与DH检测之间的中位时间间隔为9.5年。在DH出现之前，4例患者食用正常含麸质饮食，10例在GFD饮食中有饮食失误，6例严格遵循GFD饮食。19例患者中有7例乳糜泻自身抗体呈阳性，7例接受小肠活检的患者中有5例有部分绒毛萎缩。DH诊断后，严格遵循GFD饮食中位6个月后皮疹得到控制。
乳糜泻患者可能随时间发展为DH。这通常是GFD依从性差的一个指标，需要进行严格的饮食干预。在大多数情况下，DH在未预先诊断乳糜泻的情况下被检测到，但医生应认识到这种表型改变。
