title: Malignancy and survival in dermatitis herpetiformis: a comparison with coeliac disease.
abstract: BACKGROUND
  Dermatitis herpetiformis is a lifelong, gluten sensitive skin disease. Patients with dermatitis herpetiformis, similar to patients with coeliac disease not adhering to a gluten free diet, seem to have increased risk for lymphoma.
  
  
  OBJECTIVE
  This study looked at the occurrence of malignancy and survival of patients with dermatitis herpetiformis and compared the results with those seen in patients with coeliac disease or in the general population.
  
  
  METHODS
  A total of 305 adult patients with dermatitis herpetiformis diagnosed at the University Hospital of Tampere in 1970-1992 were studied. Most patients started a gluten free diet and at the end of the study 93% of the patients were adhering to the diet. A control group comprised 383 adult patients with coeliac disease, 81% of them adhered to a gluten free diet, 6% had a normal diet, and in 13% the diet history remained unknown.
  
  
  METHODS
  The occurrence of malignant diseases and survival of the patients were assessed up to the end of 1993. Standardised incidence ratios (SIR) with 95% confidence intervals were used for the malignant diseases. The survival of the patients was compared with that of the general population.
  
  
  RESULTS
  Thirteen (4.3%) patients with dermatitis herpetiformis developed 14 malignant disorders during the follow up (SIR 1.25; 95% confidence intervals 0.68 to 2.09). A non-Hodgkin's lymphoma occurred in four patients with dermatitis herpetiformis, significantly more than expected (SIR 10.3; 2.8-26.3). Thirteen (4.3%) patients with dermatitis herpetiformis died during the follow up but there was no increased general mortality. In coeliac disease, 13 (3.4%) patients developed malignancy (SIR 1.16; 0.62 to 1.97), 31 (8.1%) patients died but the survival rate did not differ from that in the general population.
  
  
  CONCLUSIONS
  The incidence of non-Hodgkin's lymphoma was significantly increased in patients with dermatitis herpetiformis. The results also confirm that the patients with dermatitis herpetiformis treated mainly with a gluten free diet have no increased general mortality.
authors.affiliation: Medical School, University of Tampere, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Collin
authors.forename: E
authors.initials: E
authors.lastname: Pukkala
authors.forename: T
authors.initials: T
authors.lastname: Reunala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy / Q000401:mortality; D002648:Child; D015331:Cohort Studies; D003874:Dermatitis Herpetiformis / Q000150:complications* / Q000178:diet therapy / Q000401:mortality; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis