title: No increase in risk of fracture, malignancy or mortality in dermatitis herpetiformis: a cohort study.
abstract: BACKGROUND
  Dermatitis herpetiformis forms part of the same spectrum of gluten-sensitive disorders as coeliac disease yet may have different risks of morbidity and mortality.
  
  
  OBJECTIVE
  To quantify the risks of fracture, malignancy and mortality in people with dermatitis herpetiformis compared with the general population.
  
  
  METHODS
  Using the General Practice Research Database, we identified 846 people with dermatitis herpetiformis and 4225 age-, gender- and practice-matched controls. We used Cox regression to estimate hazard ratios.
  
  
  RESULTS
  Comparing people with dermatitis herpetiformis to the general population, the overall hazard ratio for any fracture was 1.1 (95% CI: 0.77-1.52). The overall hazard ratio for any malignancy was 1.0 (95% CI: 0.73-1.49); there was no increased risk of gastrointestinal (HR: 1.6; 95% CI: 0.67-3.67) or lymphoproliferative cancers (HR: 1.6; 95% CI: 0.44-6.06). A reduction in risk of breast cancer was not statistically significant (HR: 0.19; 95% CI: 0.03-1.39). The hazard ratio for all-cause mortality was 0.93 (95% CI: 0.70-1.23).
  
  
  CONCLUSIONS
  Unlike the fivefold increase in risk seen in coeliac disease, we found no increased risk of lymphoproliferative cancer and no increase in fracture, malignancy or mortality in people with dermatitis herpetiformis compared with the general population. It is not clear whether differences in degree of intestinal inflammation or other reasons account for this. Like coeliac disease, dermatitis herpetiformis may protect against breast cancer.
authors.affiliation: Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK. nina.lewis@nottingham.ac.uk
authors.forename: N R
authors.initials: NR
authors.lastname: Lewis
authors.forename: R F A
authors.initials: RF
authors.lastname: Logan
authors.forename: R B
authors.initials: RB
authors.lastname: Hubbard
authors.forename: J
authors.initials: J
authors.lastname: West
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003874:Dermatitis Herpetiformis / Q000150:complications* / Q000401:mortality; D050723:Fractures, Bone / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology* / Q000401:mortality