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Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.

Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC - An Bras Dermatol (2014 Nov-Dec)

Bottom Line: These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur.Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative.Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

View Article: PubMed Central - PubMed

Affiliation: West ParanĂ¡ State University, Cascavel, PR, Brazil.

ABSTRACT
Researches on DH have shown that it is not just a bullous skin disease, but a cutaneous-intestinal disorder caused by hypersensitivity to gluten. Exposure to gluten is the starting point of an inflammatory cascade capable of forming autoantibodies that are brought to the skin, where they are deposited, culminating in the formation of skin lesions. These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur. Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative. Patients who follow gluten-free diets have better control of symptoms on the skin and intestine, as well as lower risks of progression to lymphoma. Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

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Related in: MedlinePlus

Intestinal involvement due to gluten intolerance. Colonoscopy in a healthyindividual (A), and in a patient with CD (B) highlightof intestinal villous atrophy. Intestinal histopathology on a healthy individual(C), and in a patient with CD (D) note thelymphocytic infiltrate and atrophy. The images are a courtesy from Dr. CarlosFloriano de Moraes
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f03: Intestinal involvement due to gluten intolerance. Colonoscopy in a healthyindividual (A), and in a patient with CD (B) highlightof intestinal villous atrophy. Intestinal histopathology on a healthy individual(C), and in a patient with CD (D) note thelymphocytic infiltrate and atrophy. The images are a courtesy from Dr. CarlosFloriano de Moraes

Mentions: In two thirds of patients with DH there is some degree of villous atrophy in theintestinal mucosa (Figure 3) and one third willhave an increased intraepithelial lymphocyte count.6,30 Fry describes that thefinding of up to 200 lymphocytes per 1,000 epithelial cells could exclude the diagnosisof DH.27,46 Both alterations improve noticeably early with adherence to agluten-free diet.15


Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.

Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC - An Bras Dermatol (2014 Nov-Dec)

Intestinal involvement due to gluten intolerance. Colonoscopy in a healthyindividual (A), and in a patient with CD (B) highlightof intestinal villous atrophy. Intestinal histopathology on a healthy individual(C), and in a patient with CD (D) note thelymphocytic infiltrate and atrophy. The images are a courtesy from Dr. CarlosFloriano de Moraes
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230654&req=5

f03: Intestinal involvement due to gluten intolerance. Colonoscopy in a healthyindividual (A), and in a patient with CD (B) highlightof intestinal villous atrophy. Intestinal histopathology on a healthy individual(C), and in a patient with CD (D) note thelymphocytic infiltrate and atrophy. The images are a courtesy from Dr. CarlosFloriano de Moraes
Mentions: In two thirds of patients with DH there is some degree of villous atrophy in theintestinal mucosa (Figure 3) and one third willhave an increased intraepithelial lymphocyte count.6,30 Fry describes that thefinding of up to 200 lymphocytes per 1,000 epithelial cells could exclude the diagnosisof DH.27,46 Both alterations improve noticeably early with adherence to agluten-free diet.15

Bottom Line: These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur.Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative.Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

View Article: PubMed Central - PubMed

Affiliation: West ParanĂ¡ State University, Cascavel, PR, Brazil.

ABSTRACT
Researches on DH have shown that it is not just a bullous skin disease, but a cutaneous-intestinal disorder caused by hypersensitivity to gluten. Exposure to gluten is the starting point of an inflammatory cascade capable of forming autoantibodies that are brought to the skin, where they are deposited, culminating in the formation of skin lesions. These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur. Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative. Patients who follow gluten-free diets have better control of symptoms on the skin and intestine, as well as lower risks of progression to lymphoma. Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.

Show MeSH
Related in: MedlinePlus