Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: review of the Mayo Clinic experience*^,†

Abstract

In this large series of patients with DH from a single institution, patients had a low incidence of symptomatic gluten-sensitive enteropathy, low risk of lymphoproliferative disorders, and associations with other systemic autoimmune disorders. The value of DIF testing in the diagnosis of DH was confirmed. The detection of antiendomysial antibodies by indirect immunofluorescence was less sensitive than indicated by other reports.

Possible triggering factors and comorbidities in newlydiagnosed autoimmune bullous diseases

“…Additionally, it is accepted that all DH patients have CD in theory, due to sharing a common mechanism, even though they usually have subclinical gastrointestinal disease and only mild symptoms. In our DH patients, 37.5% were diagnosed with CD by histopathological examination, whereas this was reported as 3.3%-18% in the literature (13,22).…”

“…In spite of reports that cardiovascular diseases were generally associated with BP, cardiovascular diseases were also associated with other ABDs in some case reports (13,22,24). Nevertheless, Marzano at al.…”

“…It was shown that the use of intravenous, topical, or expectorant forms of iodide had a triggering effect in BP patients in certain reports (21). In patients with DH it was reported that gluten in particular and less often milk and iodine in the diet, ultraviolet B rays, and repetitive minor trauma on extensor skin surfaces possibly had an exacerbating effect (10,13,22). In 22 DH patients reported by Zhang et al, the lesions had progressed after delivery in one of them (4.5%) and after intervertebral disc surgery in another (22).…”

“…A recent systematic review and metaanalysis provided support for a significant association between BP and neurological diseases; therefore, it was recommended that clinicians should be aware of this association and manage modifiable risk factors for neurological diseases accordingly (29). Moreover, it has been emphasized that 25% of patients with DH and gluten enteropathy also have some neuropsychiatric disorders such as epilepsy, ataxia, and dementia, and these associations are related to the neurotoxic effect of gluten (13,23). Additionally, the presence of a new antispinal antibody was determined in more than half of DH patients by Wills et al (30).…”

Celiac Disease and Autoimmunity in the Gut and Elsewhere

“…[45] A recent large, retrospective study by Alonso-Llamazares et al found a 12.6% prevalence rate of CD and 22% prevalence rate of systemic autoimmune disorders among 263 DH patients. [46] Diagnosis is made by immunoflourescent visualization of granular IgA deposits at the junction of the epidermal/dermal layers in biopsies taken close to but not in an affected area. Epidermal tissue transglutaminase (eTg) is considered one of the key target autoantigens; the intestinal inflammation occurring in CD may be associated with increased production of antibodies directed against eTg.…”