title: The Decreasing Prevalence of Severe Villous Atrophy in Dermatitis Herpetiformis: A 45-Year Experience in 393 Patients.
abstract: OBJECTIVE
  We analyzed from our prospectively collected series of patients with dermatitis herpetiformis (DH) whether small-bowel histologic findings are changing and how serum tissue transglutaminase (TG2) IgA antibodies correlate to mucosal damage.
  
  
  BACKGROUND
  DH is an extraintestinal manifestation of celiac disease presenting with itchy blistering rash and pathognomonic IgA deposits in the skin. Prominent gastrointestinal symptoms are rare, and small-bowel findings range from severe villous atrophy (SVA) and partial villous atrophy (PVA) to normal mucosa with inflammatory changes.
  
  
  METHODS
  The cohort included 393 patients (214 male and 179 female) with DH having small-bowel biopsies performed at Tampere University Hospital since 1970. The small-bowel findings were calculated in the three 15-year periods, and in the last period they were correlated with serum IgA class TG2 antibody levels measured by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  The prevalence of SVA decreased significantly (P=0.032), from 42% in the first study period to 29% in the last study period. A concomitant increase was seen in PVA, from 33% to 41%, and normal villous architecture, from 25% to 30%. The patients with SVA (P<0.001) and PVA (P=0.046) had significantly higher TG2 antibody levels than those with normal villous architecture.
  
  
  CONCLUSIONS
  This long-term study in patients with DH disclosed a significant decrease in the occurrence of SVA. Serum IgA TG2 antibody levels correlated to damage in the small bowel. The trend toward milder small-bowel histology in DH suggests that a similar pattern could occur in the pool of undiagnosed celiac disease from which DH develops.
authors.affiliation: Departments of *Dermatology ¶Internal Medicine #Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital †School of Medicine, University of Tampere, Tampere ‡Unit of Primary Health Care, Helsinki University Central Hospital §Department of General Practice, University of Helsinki, Helsinki ∥Unit of Primary Health Care, Kuopio University Hospital, Helsinki and Kuopio, Finland.
authors.forename: Eriika
authors.initials: E
authors.lastname: Mansikka
authors.forename: Kaisa
authors.initials: K
authors.lastname: Hervonen
authors.forename: Teea T
authors.initials: TT
authors.lastname: Salmi
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Timo
authors.initials: T
authors.lastname: Reunala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001323:Autoantibodies / Q000097:blood; D015331:Cohort Studies; D003874:Dermatitis Herpetiformis / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D055050:Diet, Gluten-Free; D005260:Female; D005387:Finland / Q000453:epidemiology; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012720:Severity of Illness Index; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins