title: Celiac disease evolving into dermatitis herpetiformis in patients adhering to normal or gluten-free diet.
abstract: OBJECTIVE
  Dermatitis herpetiformis (DH) is a cutaneous form of celiac disease affecting ∼ 17% of celiac disease patients. The aim was to determine how often celiac disease precedes the development of DH, and what is the impact of gluten-free diet (GFD) in this phenotype change.
  
  
  METHODS
  Our prospectively collected DH series from 1970 comprised 514 patients. We analyzed all DH patients who at least 2 years earlier had been diagnosed with celiac disease. DH diagnosis was confirmed by showing immunoglobulin A deposits in dermis. Serological and small bowel mucosal findings were analyzed, and the strictness of GFD treatment before and after the diagnosis of DH was evaluated.
  
  
  RESULTS
  Twenty (4%) DH patients had a prior diagnosis of celiac disease. The median time interval between celiac disease and DH detection was 9.5 years. Before DH appeared 4 patients had been on a normal gluten-containing diet, 10 had dietary lapses on a GFD, and 6 were on a strict GFD. Celiac autoantibodies were positive in 7 out of 19 patients, and 5 out of 7 undergoing small bowel biopsy had partial villous atrophy. Following DH diagnosis the rash was controlled after a median of 6 months on a strict GFD.
  
  
  CONCLUSIONS
  Patients with celiac disease may develop DH by time. This is most often an indicator of poor adherence to GFD, and a rigorous dietary intervention is necessary. In the majority of cases, DH will be detected without prior celiac disease diagnosis, but the physicians should recognize this phenotype alteration.
authors: Department of Dermatology, Tampere University Hospital , Tampere , Finland.
authors: Teea T
authors: TT
authors: Salmi
authors: Kaisa
authors: K
authors: Hervonen
authors: Kalle
authors: K
authors: Kurppa
authors: Pekka
authors: P
authors: Collin
authors: Katri
authors: K
authors: Kaukinen
authors: Timo
authors: T
authors: Reunala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D001323:Autoantibodies / Q000097:blood; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003874:Dermatitis Herpetiformis / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010641:Phenotype; D013997:Time Factors; D055815:Young Adult
chemical_list: D001323:Autoantibodies
keywords: celiac disease; dermatitis herpetiformis; follow-up; gluten-free diet