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


OBJECTIVE
To investigate the effects on long-term remission of dermatitis herpetiformis in patients who underwent a gluten challenge and subsequently reintroduced dietary gluten.


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.
Bardella
M T
MT
Cattedra di Gastroenterologia, Dipartimento di Scienze Mediche IRCCS Ospedale Maggiore, Università degli Studi di Milano, Milano, Italy. mariateresa.bardella@unimi.it
Fredella
C
C
Trovato
C
C
Ermacora
E
E
Cavalli
R
R
Saladino
V
V
Prampolini
L
L
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003622:Dapsone / Q000627:therapeutic use; D003874:Dermatitis Herpetiformis / Q000178:diet therapy* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens / Q000008:administration & dosage* / Q000633:toxicity; D006650:Histocompatibility Testing; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012008:Recurrence; D012074:Remission Induction
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005983:Glutens; D003622:Dapsone