Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
Department of Dermatology, University of Utah School of Medicine, Salt Lake City.
JAMA Dermatol. 2017 Mar 1;153(3):315-318. doi: 10.1001/jamadermatol.2016.4676.
Dermatitis herpetiformis (DH) is an autoimmune blistering condition seen in the context of celiac disease. While typically managed by gluten-free diet and dapsone, treatment of DH refractory to standard treatments is not well defined.
A man in his 80s with DH not controlled by gluten-free diet (with poor adherence), dapsone, and conventional immune-suppressing agents responded to treatment with rituximab according to the lymphoma protocol (4 weekly infusions of 375 mg/m2). Thirteen months after treatment, the patient had achieved complete resolution of pruritus and clinical manifestations of the disease, as well as normalization of antibodies against epidermal and tissue transglutaminases. He achieved complete clinical and serological remission and has remained symptom-free up to 18 months following treatment.
We present here the first case of a patient with DH treated with rituximab who achieved complete clinical and serological remission. We suggest rituximab as a viable treatment option for recalcitrant DH.
疱疹样皮炎（DH）是一种与乳糜泻相关的自身免疫性水疱性疾病。虽然通常通过无麸质饮食和氨苯砜治疗，但对标准治疗反应不佳的 DH 的治疗方法尚未明确。
一名 80 多岁的男性患有 DH，无麸质饮食（依从性差）、氨苯砜和常规免疫抑制剂治疗无效，根据淋巴瘤方案（每 4 周输注 375mg/m2）接受利妥昔单抗治疗。治疗 13 个月后，患者瘙痒和疾病临床表现完全缓解，以及针对表皮和组织转谷氨酰胺酶的抗体也恢复正常。他达到了完全的临床和血清学缓解，并且在治疗后 18 个月内一直无症状。
我们在此提出首例接受利妥昔单抗治疗的 DH 患者的病例，该患者达到完全的临床和血清学缓解。我们建议利妥昔单抗作为一种可行的治疗选择，用于难治性 DH。
