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    Guts of Patients with Refractory Dermetitis Herpetiformis Respond to Gluten-free Diet


    Jefferson Adams


    • New research shows that guts of patients with refractory dermetitis herpetiformis respond to a gluten-free diet.


    Image Caption: Refractory dermatitis herpetiformis different than refractory celiac disease. Photo: CC--ProVillage9991

    Celiac.com 02/09/2017 - Dermatitis herpetiformis is a skin disease that causes blistering, and is understood to be an external symptom of celiac disease. Refractory celiac disease, which does not respond to a gluten-free diet and which carries an increased risk of lymphoma, is well-known to clinicians and researchers.


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    A team of researchers recently set out to determine if there were any cases of refractory dermatitis herpetiformis with active rash and persistent small bowel atrophy that do not respond to a gluten-free diet. The research team included K Hervonen, TT Salmi, T Ilus, K Paasikivi, M Vornanen, K Laurila, K Lindfors, K Viiri, P Saavalainen, P Collin, K Kaukinen, and T Reunala. They are affiliated with the Department of Dermatology, Tampere University Hospital and University of Tampere, in Tampere, Finland.

    For their study, the team analyzed their series of 403 patients with dermatitis herpetiformis. They found seven patients (1.7%), who had been on a gluten-free diet for a mean of 16 years, but who still required dapsone to treat the symptoms of dermatitis herpetiformis. Of these, one patient died from mucinous adenocarcinoma before re-examination. At re-examination, the team found skin immunoglobulin A (IgA) deposits in 5 of 6 refractory and 3 of 16 control dermatitis herpetiformis patients with good dietary response.

    At reexamination, they studied small bowel mucosa from 5 refractory and 8 control dermatitis herpetiformis patients; results were normal in all 5 refractory and 7 of 8 control dermatitis herpetiformis patients. One refractory dermatitis herpetiformis patient died from adenocarcinoma, but none of the patients developed lymphoma.

    This study marks the first time doctors have seen small bowel mucosa healing in patients with refractory dermatitis herpetiformis, where the rash is non-responsive to a gluten-free diet. This means that even though dermatitis herpetiformis sufferers may still have a rash, they can also have a healthy gut.

    This is sharply different from refractory celiac disease, where small bowel mucosa do not heal on a gluten-free diet.

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  • Related Articles

    Jefferson Adams
    Celiac.com 12/29/2011 - About one in 100 people in America has celiac disease, while about one in four of those will develop dermatitis herpetiformis Duhring, which occurs when celiac disease manifests cutaneously, in the skin. Dermatitis herpetiformis Duhring is uncommon in children, with only 5% of cases appearing in children younger than 7 years. Most often, it presents in people over forty.
    Making a proper clinical diagnosis of dermatitis herpetiformis Duhring, also known as Duhring’s disease, is challenging, and often requires the help of skin biopsy and direct immunofluorescence.
    To do this, clinicians should look for antibodies against gliadin, endomysium, and transglutaminase, said Dr. Magdalene A. Dohil, of the University of California, San Diego, at a seminar sponsored by Skin Disease Education Foundation (SDEF).
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    Source:

    http://www.skinandallergynews.com/news/medical-dermatology/single-article/diseases-of-the-gut-may-present-cutaneously/57197f4ef7.html

    Miranda Jade
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    As a celiac with dermatitis herpetiformis, completely eliminating gluten from my diet has been the only lasting solution for dermatitis herpetiformis, but unfortunately I can accidentally ingest gluten from time to time, especially when I travel. In my most recent outbreak, I decided to get a prescription for dapsone. Although dapsone is a very strong drug with side effects and should be used sparingly, I was in need of something fast-acting. I followed the instructions exactly, and not only did it relieve the pain but within three days, I could see a remarkable change in the appearance of the dermatitis herpetiformis. After reexperiencing the painful and frustrating symptoms of dermatitis herpetiformis and the relief that came with proper treatment, I knew I had to address this topic to help others. I encourage everyone to get the word out about dermatitis herpetiformis so more and more people dealing with this misdiagnosed condition can get help just as I did.
    Resources:
    About.com: Dermatitis Herpetiformis, The ‘Gluten Rash’. Celiac Disease Awareness Campaign: Dermatitis Herpetiformis. eMedecine.Medscape.com: Dermatitis herpetiformis.

    Jefferson Adams
    Celiac.com 11/13/2013 - Dermatitis herpetiformis is the cutaneous manifestation of celiac disease. Both celiac and dermatitis herpetiformis are diseases of gluten-sensitivity.
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    Source:
    Rev Esp Enferm Dig. 2013 Apr;105(4):187-193.

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    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
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