title: Remission in dermatitis herpetiformis: a cohort study.
abstract: OBJECTIVE
  To determine the percentage of patients with dermatitis herpetiformis (DH) who experience at least 2 years of remission and to identify factors associated with DH remission.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  National Institutes of Health (NIH).
  
  
  METHODS
  Patients seen at the NIH during the 1972-2010 period who had clinical findings consistent with DH, whose normal skin showed the presence of granular IgA deposits at the dermoepidermal junction on direct immunofluorescence (DIF) examination, whose age of disease onset was known, who had DH for at least 2 years, and who were followed up for at least 3 years after the initial NIH visit.
  
  
  METHODS
  Remission, defined as absence of skin lesions and symptoms of DH for more than 2 years while not taking sulfones (dapsone or sulfoxone), sulfapyridine, anti-tumor necrosis factor agents, or oral steroids and not adhering to a gluten-free diet.
  
  
  RESULTS
  Among 86 patients, in 10 (12%) the disease underwent remission (95% confidence interval, 6%-20%). Factors associated with DH remission included DH age of onset at 39 years or older vs onset at ages 8 to 38 years (unadjusted P = .02; adjusted P = .07) and DH onset year between 1960 and 1972 vs onset between 1935 and 1959 or after 1972 (P = .02 for global comparison of 4 onset-year groups).
  
  
  CONCLUSIONS
  Dermatitis herpetiformis can go into remission. Clinicians should attempt to wean patients with well-controlled DH from a gluten-free diet and/or use of sulfones or other therapies to determine if the DH might have remitted. Our findings provide insight into the pathogenesis and course of this disease and may serve to guide long-term management of patients with DH.
authors.affiliation: Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Paek
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003874:Dermatitis Herpetiformis / Q000178:diet therapy / Q000188:drug therapy / Q000503:physiopathology*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D055050:Diet, Gluten-Free / Q000379:methods*; D005260:Female; D019085:Fluorescent Antibody Technique, Direct / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D007070:Immunoglobulin A; D013450:Sulfones