Long-term remission in patients with dermatitis herpetiformis on a normal diet

M. T. Bardella, C. Fredella, C. Trovato, E. Ermacora, R. Cavalli, V. Saladino, L. Prampolini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A life-long gluten-free diet is the treatment of choice for dermatitis herpetiformis, which is considered to be coeliac disease of the skin. Objectives: To investigate the effects on long-term remission of dermatitis herpetiformis in patients who underwent a gluten challenge and subsequently reintroduced dietary gluten. Patients and methods: We studied 38 patients (14 male and 24 female) with biopsy-confirmed dermatitis herpetiformis. They had followed a gluten-free diet for a mean of 8 years, achieving clinical remission and intestinal normalization. The patients were asked to reintroduce gluten in their diet and agreed to undergo skin and intestinal biopsies during the follow-up. Results: Of the 38 patients abandoning a gluten-free diet, 31 reported the onset of rash within an average of 2 months. Seven subjects (three males, mean age 15 years at challenge) experienced no clinical or histological relapses (median follow-up 12 years), and lost IgA immunoglobulin from the skin. The two series of patients differed in terms of age at diagnosis (mean age: 26-6 vs. 6 years), the use of dapsone (one of 31 vs. four of seven) and adherence to the gluten-free diet (strict compliance in 26 of 31 vs. none of seven). Conclusions: Our data suggest that the ingestion of small doses of gluten in childhood and/or the use of an anti-inflammatory drug may modify the immunological response inducing immune tolerance. We report long-term clinical and histological remissions in seven patients with dermatitis herpetiformis after the reintroduction of dietary gluten.

Original languageEnglish
Pages (from-to)968-971
Number of pages4
JournalBritish Journal of Dermatology
Volume149
Issue number5
DOIs
Publication statusPublished - Nov 2003

Keywords

  • Coeliac disease
  • Dermatitis herpetiformis
  • Gluten reintroduction
  • Gluten-free diet
  • Remission

ASJC Scopus subject areas

  • Dermatology

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