Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease
Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, 33014 Tampere, Finland
Department of Dermatology, Tampere University Hospital, 33521 Tampere, Finland
Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33521 Tampere, Finland
Author to whom correspondence should be addressed.
Nutrients 2018, 10(5), 602; https://doi.org/10.3390/nu10050602
Received: 13 April 2018 / Revised: 4 May 2018 / Accepted: 9 May 2018 / Published: 12 May 2018
(This article belongs to the Special Issue Extraintestinal Manifestations of Coeliac Disease)
Dermatitis herpetiformis (DH) is a common extraintestinal manifestation of coeliac disease presenting with itchy papules and vesicles on the elbows, knees, and buttocks. Overt gastrointestinal symptoms are rare. Diagnosis of DH is easily confirmed by immunofluorescence biopsy showing pathognomonic granular immunoglobulin A (IgA) deposits in the papillary dermis. A valid hypothesis for the immunopathogenesis of DH is that it starts from latent or manifest coeliac disease in the gut and evolves into an immune complex deposition of high avidity IgA epidermal transglutaminase (TG3) antibodies, together with the TG3 enzyme, in the papillary dermis. The mean age at DH diagnosis has increased significantly in recent decades and presently is 40–50 years. The DH to coeliac disease prevalence ratio is 1:8 in Finland and the United Kingdom (U.K.). The annual DH incidence rate, currently 2.7 per 100,000 in Finland and 0.8 per 100,000 in the U.K., is decreasing, whereas the reverse is true for coeliac disease. The long-term prognosis of DH patients on a gluten-free diet is excellent, with the mortality rate being even lower than for the general population.