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Review: dermatitis herpetiformis.

Mendes FB, Hissa-Elian A, Abreu MA, Gonçalves VS - An Bras Dermatol (2013 Jul-Aug)

Bottom Line: The same protein IgA1 with J chain is found in the small intestinal mucosa in patients with adult celiac disease, suggesting a strong association with DH.Autoimmune diseases present higher levels of prevalence, such as thyroid (5-11%), pernicious anemia (1-3%), type 1 diabetes (1-2%) and collagen tissue disease.The chosen treatment is dapsone and a gluten-free diet.

View Article: PubMed Central - PubMed

Affiliation: Presidente Prudente Regional Hospital, University of Oeste Paulista, Presidente Prudente(SP),Brazil.

ABSTRACT
Dermatitis herpetiformis (DH) or Duhring-Brocq disease is a chronic bullous disease characterized by intense itching and burning sensation in the erythematous papules and urticarial plaques, grouped vesicles with centrifuge growth, and tense blisters. There is an association with the genotypes HLA DR3, HLA DQw2, found in 80-90% of cases. It is an IgA-mediated cutaneous disease, with immunoglobulin A deposits appearing in a granular pattern at the top of the dermal papilla in the sublamina densa area of the basement membrane, which is present both in affected skin and healthy skin. The same protein IgA1 with J chain is found in the small intestinal mucosa in patients with adult celiac disease, suggesting a strong association with DH. Specific antibodies such as antiendomysium, antireticulina, antigliadin and, recently identified, the epidermal and tissue transglutaminase subtypes, as well as increased zonulin production, are common to both conditions, along with gluten-sensitive enteropathy and DH. Autoimmune diseases present higher levels of prevalence, such as thyroid (5-11%), pernicious anemia (1-3%), type 1 diabetes (1-2%) and collagen tissue disease. The chosen treatment is dapsone and a gluten-free diet.

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Related in: MedlinePlus

Direct immunofluorescence. Fluorescence in granular pattern in the basementmembrane zone
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f04: Direct immunofluorescence. Fluorescence in granular pattern in the basementmembrane zone

Mentions: The direct immunofluorescence of perilesional skin affected is the gold standard toconfirm the diagnosis with the deposition of IgA1 in granular pattern in the laminalucida of the basement membrane zone (Figure 4).2,9,34,35 Less than 5% of cases present deposits of IgA in alinear pattern, which must be distinguished from linear IgA dermatosis. 7 A fibrillar IgA standard deposit isreportedly found in 50% of the Japanese population with HD, but several authors havequestioned whether it corresponds to a variant of DH, a different disease, or only to analternating pattern consequent longitudinal and transverse orientation of microfibrils,visualized through an electron microscopy, as suggested by Ko CJ et al.36 Sometimes, it is necessary tocarry out a second test for the diagnosis because, during the early stages of thedisease, this typical feature may not be found. The deposit of immunoglobulin A does notchange with dapsone, but approximately two years of gluten-free diet abolishes thisfinding. 1


Review: dermatitis herpetiformis.

Mendes FB, Hissa-Elian A, Abreu MA, Gonçalves VS - An Bras Dermatol (2013 Jul-Aug)

Direct immunofluorescence. Fluorescence in granular pattern in the basementmembrane zone
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3760935&req=5

f04: Direct immunofluorescence. Fluorescence in granular pattern in the basementmembrane zone
Mentions: The direct immunofluorescence of perilesional skin affected is the gold standard toconfirm the diagnosis with the deposition of IgA1 in granular pattern in the laminalucida of the basement membrane zone (Figure 4).2,9,34,35 Less than 5% of cases present deposits of IgA in alinear pattern, which must be distinguished from linear IgA dermatosis. 7 A fibrillar IgA standard deposit isreportedly found in 50% of the Japanese population with HD, but several authors havequestioned whether it corresponds to a variant of DH, a different disease, or only to analternating pattern consequent longitudinal and transverse orientation of microfibrils,visualized through an electron microscopy, as suggested by Ko CJ et al.36 Sometimes, it is necessary tocarry out a second test for the diagnosis because, during the early stages of thedisease, this typical feature may not be found. The deposit of immunoglobulin A does notchange with dapsone, but approximately two years of gluten-free diet abolishes thisfinding. 1

Bottom Line: The same protein IgA1 with J chain is found in the small intestinal mucosa in patients with adult celiac disease, suggesting a strong association with DH.Autoimmune diseases present higher levels of prevalence, such as thyroid (5-11%), pernicious anemia (1-3%), type 1 diabetes (1-2%) and collagen tissue disease.The chosen treatment is dapsone and a gluten-free diet.

View Article: PubMed Central - PubMed

Affiliation: Presidente Prudente Regional Hospital, University of Oeste Paulista, Presidente Prudente(SP),Brazil.

ABSTRACT
Dermatitis herpetiformis (DH) or Duhring-Brocq disease is a chronic bullous disease characterized by intense itching and burning sensation in the erythematous papules and urticarial plaques, grouped vesicles with centrifuge growth, and tense blisters. There is an association with the genotypes HLA DR3, HLA DQw2, found in 80-90% of cases. It is an IgA-mediated cutaneous disease, with immunoglobulin A deposits appearing in a granular pattern at the top of the dermal papilla in the sublamina densa area of the basement membrane, which is present both in affected skin and healthy skin. The same protein IgA1 with J chain is found in the small intestinal mucosa in patients with adult celiac disease, suggesting a strong association with DH. Specific antibodies such as antiendomysium, antireticulina, antigliadin and, recently identified, the epidermal and tissue transglutaminase subtypes, as well as increased zonulin production, are common to both conditions, along with gluten-sensitive enteropathy and DH. Autoimmune diseases present higher levels of prevalence, such as thyroid (5-11%), pernicious anemia (1-3%), type 1 diabetes (1-2%) and collagen tissue disease. The chosen treatment is dapsone and a gluten-free diet.

Show MeSH
Related in: MedlinePlus