Dermatitis herpetiformis: Gastrointestinal association

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

“…A higher percentage, up to 93%, may be included if an increased intraepithelial lymphocyte count in the intestinal microvilli is used as a criterion for the diagnosis 33 . We accept the fact that most patients with DH have abnormal findings in the intestinal biopsy consistent with asymptomatic GSE; 34 however, we were more interested in the prevalence of established CD (or symptomatic GSE) diagnosed on the basis of recognized clinicopathologic criteria at the time the diagnosis was made 35 . Furthermore, we are aware of the limitations of this retrospective study in this regard, and acknowledge that, if current criteria to establish a diagnosis of CD had been used in this cohort of patients, the prevalence of patients with both DH and CD may have been higher 36,37 …”

Dermatitis herpetiformis in China: a report of 22 cases

“…Subepidermal blisters and neutrophilic microabscesses in the dermal papillary tips are characteristically observed upon histopathological examination. The granular deposition of IgA in the dermal papillae as shown by direct immunofluorescence (DIF) is the gold standard for the diagnosis of DH, which is viewed as a cutaneous manifestation of coeliac disease (CD), a type of gluten‐sensitive enteropathy (GSE) 3 . Multiple small‐intestinal biopsies show that nearly all patients have some degree of associated CD, but only a few patients have mild gastrointestinal signs and symptoms 4 .…”

Dermatitis Herpetiformis: Should Direct Immunofluorescence Be the Only Diagnostic Criterion?

“…Several antibodies have been described in DH, and all correlate with intestinal lesions: antigliadin (AGA), antireticulin (ARA), and antiendomysial (EMA) (7–10). The latter is detected by a semiquantitative indirect immunofluorescence method and is considered the most sensitive and specific marker of small intestine pathology (sensitivity >80%; specificity 100%) (7,10).…”