Patients with dermatitis herpetiformis (DH) have a gluten-sensitive enteropathy and while on gluten-containing diets have elevated levels of serum IL-8. We hypothesized that the mucosal immune response to gluten is responsible for the elevated serum IL-8. Six DH patients were studied while on a gluten-free diet (GFD), whereas four continued on a normal diet. Patients were followed for a mean 2.2 years and serum IL-8 was analyzed. Small bowel biopsies from five DH patients on normal diets, two DH patients on GFD, and six subjects with no small bowel abnormalities were analyzed for IL-8 mRNA. Serum IL-8 levels normalized in five of six patients on GFD and decreased in one, whereas serum IL-8 levels showed no statistically significant change in DH patients on normal diets. Small bowel biopsies from DH patients on normal diets had increased expression of IL-8 mRNA compared to normal subjects, whereas patients on a GFD showed no significant increase in small bowel mRNA. No significant IL-8 mRNA was detected in normal skin biopsies from patients with DH. These observations suggest that the IL-8 in the serum of patients with DH originates from the small bowel as a mucosal immune response to gluten ingestion.

Background: Combination laser treatments can potentially increase the effectiveness of treatment without the additional downtime associated with another procedure. Objective: To assess the effectiveness and safety of combining non-ablative fractional treatments with optimized intense pulsed light. Methods and Materials: Ten subjects (Group A) received full face treatments with a non-ablative fractional either followed or preceded by an optimized intense pulsed light source. Twenty-six subjects (Group B) received only full face treatments with the same non-ablative, fractional laser device. Results: For Group A, the overall average Fitzpatrick Wrinkle Scale for all patients improved from 6.3 AE 1.1 at baseline to 5.9 AE 0.8 one month following one treatment for an average improvement of 0.4 AE 0.6 (P < 0.10 paired t-test n ¼ 9). The average pigment improvement score was 1.8 AE 0.9 on a 4-point scale. In Group B, the average Fitzpatrick Wrinkle Scale improved from 6.0 AE 1.6 at baseline to 5.2 AE 1.4 at 3 months for an average improvement of 0.8 AE 0.7 (P < 0.001, n ¼ 26 paired t-test). The average pigment improvement score was 1.4 AE 1.0 (P < 0.001, t-test, n ¼ 26). Adverse events were similar in the two groups. Conclusion: The combination of an optimized intense pulsed light source with a non-ablative fractional laser during the same treatment session is safe and effective.

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