Gluten-free diet and reintroduction of gluten in dermatitis herpetiformis

Fry, Lionel

doi:10.1001/archderm.100.2.129

Cited by 38 publications

(24 citation statements)

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“…The enteropathy in these patients is similar to that found in adult coeliac disease since it responds to a glutenfree diet (Fry, McMinn, Cowan, Hoffbrand, 1968Shuster, Watson, and Marks, 1968;Marks and Whittle, 1969), and relapses on the re-introduction of gluten (Fry et al, 1969). Recently, Gebhard, Katz, the characteristic response of the rash to dapsone are not in themselves diagnostic.…”

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confidence: 56%

“…This suggestion is supported by the finding of a low incidence of clinical and laboratory evidence of malabsorption (Fry et al, 1967;Shuster et al, 1968;Marks and Whittle, 1969). It is now well established, however, that the enteropathy, although mild, is due to gluten sensitivity (Fry et al, 1968(Fry et al, , 1969Shuster et al, 1968;Weinstein, Brow, Parker, and Rubin, 1971).…”

Section: Discussionmentioning

confidence: 91%

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The small intestine in dermatitis herpetiformis

Fry¹,

Seah²,

Harper³

et al. 1974

J Clin Pathol

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Small intestinal biopsies from 43 patients with dermatitis herpetiformis have been studied. The diagnosis of dermatitis herpetiformis was made on clinical and histological criteria and the presence of IgA deposits in the uninvolved skin. The macroscopic appearance of the intestinal biopsy was flat in 13, convoluted in 10, leaves only in eight, and fingers and leaves in 12. Twenty small intestinal biopsies from patients who did not have dermatitis herpetiformis or gastrointestinal disorder showed leaves only in three and fingers and leaves in 17. The mean total lymphocyte count per 1000 epithelial cells for this control group was 159 +/- SE 13; for the dermatitis herpetiformis patients with flat biopsies it was 464 +/- SE 27; for the convoluted biopsies 365 +/- SE 59; for leaves only 535 +/- SE 39; and for the fingers and leaves biopsies 301 +/- SE 31. The counts for all four groups are significantly greater than the control group (P < 0.001). Three of the 43 patients with dermatitis herpetiformis had lymphocyte counts below 200 per 1000 epithelial cells, and four of our controls had counts greater than 200 but none above 300. In the control group the mean counts for lymphocytes per 1000 epithelial cells in the basal position of the intestinal epithelium was 79 +/- SE 8; in the dermatitis herpetiformis flat biopsies it was 89 +/- SE 11; for the convoluted biopsies 93 +/- SE 12; for the leaves only biopsies 121 +/- SE 18 and for the fingers and leaves 98 +/- SE 13. However, the mean lymphocyte count in the perinuclear position was 81 +/- SE 7 for the controls, 362 +/- SE 23 for the flat dermatitis herpetiformis biopsies; 251 +/- SE 46 for the convoluted specimens; 402 +/- SE 43 for the leaves only specimens, and 195 +/- SE 25 for the fingers and leaves biopsies. The mean lymphocyte count for the supranuclear position was 0.55 +/- SE 0.22 for the control group; 13.7 +/- SE 2.3 for the flat dermatitis herpetiformis biopsies; 20.0 +/- SE 6.9 for the convoluted biopsies; 14.5 +/- SE 3.3 for the leaves only biopsies; and 8.3 +/- SE 2.6 for the fingers and leaves biopsies. Thus in gluten-sensitive enteropathy the increase in lymphocytes in the intestinal epithelium is in the perinuclear and supranuclear position. The ratio of basal lymphocytes to peri- and supranuclear lymphocytes appears to be 1:1 in normal intestinal epithelium, but approximately 1:4 in the gluten-sensitive enteropathy of dermatitis herpetiformis.

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confidence: 56%

Section: Discussionmentioning

confidence: 91%

The small intestine in dermatitis herpetiformis

Fry¹,

Seah²,

Harper³

et al. 1974

J Clin Pathol

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“…It has now become clear that patients with DH may have an intestinal mucosal lesion that is similar to that seen in untreated coeliac disease which responds to gluten withdrawal in the majority of cases (Fry et al^ 1969;Shuster et al, 1968;Marks 8f Whittle, 1969). The evidence that this patient had a mucosal lesion stems from the finding of partial villous atrophy in mucosa excised at operation that was uninvolved by tumour.…”

Section: Discussionmentioning

confidence: 99%

Intestinal lymphoma complicating dermatitis herpetiformis

et al. 1977

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“…1,[18][19][20][21][22][23][24] Even with a rigorous GFD, however, IgA deposits at the dermoepidermal junction of patients with DH usually disappear slowly and may take up to several years to completely resolve. 1 Gluten challenge in such patients leads to a swift resurgence of IgA deposits in the skin and a flare of the cutaneous symptoms of DH.…”

Section: Management Key Pointsmentioning

confidence: 99%