Celiac.com 10/21/2023 - Celiac disease, an autoimmune disorder triggered by gluten consumption, has long been associated with a range of digestive symptoms. However, the story doesn't end in the digestive tract. For some individuals, celiac disease unveils itself through an unexpected medium: their skin. This presentation is known as dermatitis herpetiformis, and it's a vital but often overlooked facet of celiac disease.

Dermatitis herpetiformis, affectionately referred to as "DH" by some, is a chronic skin condition characterized by intensely itchy, blistering rashes. It might sound like a mere irritation, but DH is, in fact, the skin's way of echoing an underlying immune response to gluten ingestion. Just as celiac disease affects the small intestine, DH is its external manifestation, giving voice to the body's immunological revolt.

In our in-depth exploration of dermatitis herpetiformis, we delve into the intricacies of this unique condition. We'll unravel its connection to celiac disease, exploring why it appears and how it's diagnosed. We'll discuss the unmistakable and sometimes bewildering symptoms, along with the challenges of managing this skin condition. Moreover, we'll guide you through treatment options and offer practical advice for living a gluten-free life to keep DH at bay.

Despite its undeniable role in the larger celiac disease narrative, dermatitis herpetiformis remains an enigma for many. It's time to shed light on this aspect of celiac disease that affects the skin and, in doing so, empower those who face this condition to navigate its complexities with confidence and knowledge. So, let's embark on this enlightening journey, demystifying the link between celiac disease and the unexpected language of the skin: dermatitis herpetiformis.

Unraveling the Connection Between Dermatitis Herpetiformis and Celiac Disease

For those who have encountered dermatitis herpetiformis, the initial onset can be perplexing. Unexplained rashes and relentless itching lead many on a quest to uncover the root cause of their skin woes. This is where the intricate connection between dermatitis herpetiformis and celiac disease comes into play.

Celiac disease is a well-known autoimmune disorder, triggered by the consumption of gluten—a protein found in wheat, barley, and rye. When someone with celiac disease ingests gluten, it initiates an immune response in the small intestine. This response damages the intestinal lining, impeding the absorption of nutrients and leading to a host of gastrointestinal symptoms.

So, what's the connection between celiac disease's internal battleground and the itchy rashes of dermatitis herpetiformis? The answer lies in the immune system's memory.

Individuals with celiac disease have a particular genetic predisposition. When they consume gluten, their immune system recognizes it as an invader and produces antibodies, mainly tissue transglutaminase 2 (tTG-2). These antibodies don't limit their activity to the digestive tract; they circulate throughout the body.

Here's where dermatitis herpetiformis makes its grand entrance. The same antibodies that target the small intestine are drawn to the skin. When they reach the skin's surface, they provoke an inflammatory response. This reaction results in the characteristic blistering and intense itching of DH. In essence, DH is the skin's way of expressing the body's rejection of gluten—manifesting on the exterior what celiac disease inflicts internally.

But this dual-action response, where gluten triggers a reaction in both the intestines and the skin, also means that those with dermatitis herpetiformis often have underlying celiac disease. While not all celiacs experience DH, a substantial number do. As a result, diagnosing DH often leads to a celiac disease diagnosis, making it crucial to recognize the symptoms and understand the connection between these two conditions.

The Symptoms of Dermatitis Herpetiformis

Dermatitis herpetiformis is a skin condition known for its distinct and uncomfortable symptoms. Understanding these symptoms is crucial for timely diagnosis and management. Here, we delve into the key indicators of DH and how they affect those who experience this unique skin disorder.

1. Intensely Itchy Skin: The hallmark symptom of DH is intense itching. Affected individuals often describe the itch as deep and unrelenting. This itchiness typically precedes the appearance of the rash and can be so severe that it significantly impacts a person's quality of life. Scratching the itchy areas can further exacerbate the condition.
2. Blistering Rash: The most recognizable feature of DH is the appearance of a blistering rash. The rash typically consists of red, raised bumps or blisters filled with clear fluid. These eruptions often cluster together and create symmetrical patterns on the skin, appearing on both sides of the body. The rash's appearance can vary from person to person but is characterized by its tendency to group in clusters.
3. Elbows, Knees, and Buttocks: DH often affects specific areas of the body, with a predilection for the extensor surfaces. This means that it frequently appears on the elbows, knees, and buttocks. However, the rash can also emerge on other body parts, including the scalp, back, and shoulders.
4. Burning Sensation: In addition to itching, some individuals report a burning sensation or discomfort in the affected areas. This burning sensation can add to the overall discomfort and distress associated with the condition.
5. Skin Lesions and Scarring: If left untreated, DH can lead to skin lesions, erosions, and secondary bacterial infections. Prolonged scratching or friction can result in scarring, which, in severe cases, may be permanent.
6. Recurrence and Chronic Nature: DH tends to be a chronic condition with a relapsing-remitting pattern. Symptoms may improve and reappear over time, making it essential for individuals to have a long-term management plan.

Understanding the symptoms of dermatitis herpetiformis is vital for early recognition and proper management. It is essential for affected individuals to seek medical attention for a definitive diagnosis and to initiate appropriate treatment, often in conjunction with managing the underlying condition, celiac disease.

How To Diagnose Dermatitis Herpetiformis

Diagnosing dermatitis herpetiformis can be challenging due to its resemblance to other skin conditions. However, a correct and timely diagnosis is crucial as it often points to an underlying condition, celiac disease. Here, we'll explore the key steps involved in diagnosing DH.

1. Clinical Assessment: The diagnostic journey typically begins with a visit to a dermatologist. DH's hallmark symptom is its distinct blistering rash, but it can resemble other dermatological conditions like eczema, contact dermatitis, or even herpes. An experienced dermatologist will conduct a thorough clinical assessment, taking into account the specific characteristics of the rash, its distribution, and the accompanying symptoms such as itching and burning. The presence of the rash's unique pattern, which typically forms in clusters and symmetrical groups, can be a telling sign.
2. Skin Biopsy: In many cases, a definitive diagnosis of DH requires a skin biopsy. A small sample of the affected skin is taken and examined under a microscope. The biopsy typically reveals specific markers such as granular immunoglobulin A (IgA) deposits in the skin layers, a key indicator of DH. These IgA deposits, also found in the small intestine of those with celiac disease, provide a crucial link between DH and the underlying autoimmune condition.
3. Blood Tests: Alongside a skin biopsy, blood tests can be conducted to detect elevated levels of antibodies associated with celiac disease, particularly IgA-tissue transglutaminase (tTG) and IgA-endomysial antibodies (EMA). Finding high levels of these antibodies in the bloodstream adds another layer of evidence linking DH to celiac disease.
4. Response to a Gluten-Free Diet: Perhaps the most compelling diagnostic tool for DH is the patient's response to a gluten-free diet. If the rash and other symptoms improve or disappear with the elimination of gluten from the diet, it strongly suggests dermatitis herpetiformis in the context of celiac disease.

The diagnosis of DH can be complex, requiring a combination of clinical expertise, laboratory tests, and a dietary evaluation. Once confirmed, patients can begin effective management of both the skin condition and their underlying celiac disease, often with significant improvements in their overall health and well-being. In the following section, we'll explore strategies for managing dermatitis herpetiformis.

Home and Over the Counter Remedies for Symptoms of Dermatitis Herpetiformis

While home remedies can provide some relief from itching, it's important to note that DH typically requires medical treatment, including a gluten-free diet. Be sure to consult a healthcare professional for proper diagnosis and treatment. Here are some home remedies that may help alleviate itching associated with dermatitis herpetiformis:

Prescription Treatments for Symptoms of Dermatitis Herpetiformis

Dermatitis herpetiformis is typically treated with prescription medications aimed at controlling the symptoms and underlying condition, which is celiac disease. The primary treatment for DH is a strict gluten-free diet, as DH is closely associated with gluten intolerance. Additionally, medications are often prescribed to manage the skin symptoms. Common prescription treatments for DH include:

• Dapsone: Dapsone is the most commonly prescribed medication for DH. It is an oral medication that belongs to the sulfone class of drugs. Dapsone helps reduce skin inflammation, itching, and the formation of new blisters. It is usually started at a low dose and gradually increased as needed. Regular blood tests are necessary to monitor potential side effects, such as changes in blood cell counts.
• Dupixent: Some members here have reported that Dupixent offers relief, and it may not have as many negative side-effects as Dapsone.
• Topical Steroids: In addition to oral medications, topical corticosteroid creams or ointments may be prescribed to reduce itching and inflammation. These are applied directly to the affected skin and should be used as directed by a healthcare provider.
• Oral Corticosteroids: In cases of severe flare-ups or when Dapsone is not well-tolerated, oral corticosteroids like prednisone may be prescribed for short periods to quickly control symptoms. Long-term use of oral corticosteroids is generally avoided due to potential side effects.
• Sulfapyridine: Sulfapyridine is sometimes used as an alternative to Dapsone. It is also an oral medication that can help control DH symptoms. Like Dapsone, regular blood tests are necessary to monitor for side effects.
• Immunosuppressants: In some cases, immunosuppressive medications such as azathioprine or methotrexate may be prescribed to control DH symptoms. These medications work by suppressing the immune system's response that leads to skin inflammation. They are typically considered when other treatments are ineffective or not well-tolerated.

It's crucial to work closely with a healthcare provider, preferably a dermatologist and a gastroenterologist, if you have dermatitis herpetiformis. They can properly diagnose the condition, monitor your progress, and adjust your treatment plan as needed. Additionally, regular follow-up appointments are important to assess the effectiveness of treatment and manage any potential side effects of medications. Remember that self-diagnosis and self-treatment are not recommended for DH, and medical guidance is essential for effective management.

Celiac.com 04/28/2021 - Dermatitis herpetiformis is an external skin manifestation of gluten sensitivity. In people with dermatitis herpetiformis, an autoimmune response targets transglutaminase 3 (TG3) in the skin. Transglutaminase 2 (TG2) is a celiac disease autoantigen marked by the presence of enteropathy, while TG6 is the autoantigen that plays a role in neurological manifestations of gluten sensitivity. 

Researchers don't fully understand the interplay between B cell responses to these three transglutaminases in developing the clinical spectrum of disease manifestations. They also do not fully understand the individual or combined diagnostic and predictive value of the respective autoantibodies. 

To get a better idea of those values, a team of researchers recently assessed rates of TG6 antibodies in a group of patients with dermatitis herpetiformis.

The research team included Marios Hadjivassiliou, Timo Reunala, Kaisa Hervonen, Pascale Aeschlimann, and Daniel Aeschlimann. They are variously affiliated with the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust and University of Sheffield in Sheffield, UK; the Department of Dermatology, Tampere University Hospital in Tampere, Finland; the Celiac Disease Research Center, Tampere University and Faculty of Medicine and Health Technology in Tampere, Finland; and the Matrix Biology and Tissue Repair Research Unit, College of Biomedical and Life Sciences, School of Dentistry, Cardiff University in Cardiff, UK.

The team looked at rates of TG6 antibodies in a group of 33 patients with dermatitis herpetiformis. Thirteen of the 33 patients (39%) were positive for TG6, 11 for IgA, three for IgG, and one for both. This was substantially higher than the 14% rate seen classic celiac disease cases in a Finnish population. 

Sixty percent of dermatitis herpetiformis patients with no enteropathy, ten patients in all, were TG6 positive, compared with 17% percent of those showing overt enteropathy, twelve in all (Marsh IIIB). 

Gluten-Free Diet Improves TG6 Antibody Levels

After one year on a gluten-free diet, repeat testing showed that seven patients were TG6 negative, while 85% (11 of 13) showed reduced titers for TG6 antibodies. Four patients seroconverted and tested positive for TG6 antibodies at one year, due to the ongoing exposure to gluten. 

The team reports another patient who presented with encephalopathy leading to the diagnosis of celiac disease, who was intermittently adhering to a gluten-free diet. 

At baseline serological testing, the patient was positive for antibodies to all 3 transglutaminases. Eleven years later, he developed dermatitis herpetiformis, and eventually developed ataxia and peripheral neuropathy. 

Even though TG3 and TG6 autoantibodies are associated to certain disease expressions, TG2, TG3, and TG6 autoantibodies can be present across the spectrum of GRD patients, and may develop years before extra-intestinal symptoms appear. 

This supports the idea that gluten-dependent adaptive immunity is a necessary, but not sufficient condition for the development of organ-specific damage. 

TG6 antibodies seem to develop more frequently in patients with gluten intolerance, but, either there was no development of the molecular state driving the tissue damage in the gut, or more likely perhaps, a greater resistance to developing the phenotype in the first place.

Read the full report in Nutrients 2020, 12(9), 2884

Celiac.com 12/11/2020 - Researchers and clinicians have recently begun to understand dermatitis herpetiformis as an external, skin-affected form of celiac disease. Over 90% of people with DH have an associated gluten-sensitive enteropathy, but just 20% of dermatitis herpetiformis patients show classic gastrointestinal symptoms when first diagnosed.

A team of researchers recently released a survey study describing the frequency of dermatitis herpetiformis among patients included in the iCureCeliac network, along with demographics of patients with dermatitis herpetiformis and underlying celiac disease.

The research team included Bridget E. Shields, MD; Joel M. Gelfand, MD, MSCE; Lynne Allen-Taylor, PhD; and Misha Rosenbach, MD. They are variously affiliated with the Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Deputy Editor, JAMA Dermatology
 
Dermatologists may be the first to diagnose patients with celiac disease via their dermatitis herpetiformis, but very little nationwide data exists on the demographic characteristics of patients with dermatitis herpetiformis and celiac disease. 

Using a patient-powered research network (PPRN), their study describes the rate of dermatitis herpetiformis, records the demographics of patients with dermatitis herpetiformis and underlying celiac disease, and  assesses the amount of gluten-free diet counseling received by patients with and without dermatitis herpetiformis.

The understanding of dermatitis herpetiformis as a definite external manifestation of celiac disease is new, and offers powerful insight into new treatment approaches for dermatitis herpetiformis. 

Read more on their study in JAMA Dermatology. Published online October 7, 2020. 
 

Celiac.com 11/20/2019 - Both atopic dermatitis and celiac disease are often accompanied by other immune-mediated disorders. A team of researchers recently set out to see if they could find a connection between atopic dermatitis and celiac disease in a broad community-based population.

The research team included Guy Shalom, Khalaf Kridin, Keren-Or Raviv, Tamar Freud, Doron Comaneshter, Rivka Friedland, Arnon D. Cohen, and Dan Ben-Amitai.

The team conducted a cross-sectional observational design, in which they collected demographic and clinical data for patients enrolled in a large health management organization who were diagnosed with atopic dermatitis by a dermatologist in 2002–17. 

They recorded presence of celiac disease and celiac-related morbidities for the entire group, for adults over 18 years old, and for adults with moderate-to-severe atopic dermatitis. They then compared the findings with a matched control group without atopic dermatitis.

The study group included 116,816 patients, with a total of 45,157 adults, along with 1,909 adult adults with moderate-to-severe atopic dermatitis. 

Multivariate analysis showed that atopic dermatitis was associated with a significantly higher rates of celiac disease across the entire study population, and for each study group.

The results showed a meaningful connection between atopic dermatitis and celiac disease, and demonstrate the need for timely screening of people with atopic dermatitis for gastrointestinal morbidities.

Read more in the American Journal of Clinical Dermatology

The researchers in this study are variously affiliated with the team of researchers recently set out to Clalit Health ServicesTel Aviv, Israel; the Division of Community Health, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care Ben Gurion University of the Negev Beer-Sheva, Israel; the Department of Dermatology Rambam Health Care Campus, Haifa, Israel; the Pediatric Dermatology Unit Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; the Chief Physician’s Office, Clalit Health Services Tel Aviv, Israel; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Celiac.com 01/28/2019 - Research shows that people with celiac disease have an increased risk of bone fractures, compared to the regular population, but there's not much good data on fracture risk in patients with dermatitis herpetiformis. A team of researchers recently compared self-reported bone fractures in patients with dermatitis herpetiformis against those with celiac disease. 

The research team included C Pasternack, E Mansikka, K Kaukinen, K Hervonen, T Reunala, P Collin, H Huhtala, VM Mattila, and T Salmi. In all, they looked at self-reported fracture rates in 222 dermatitis herpetiformis patients, and in 129 control subjects with celiac disease. 

The team provided a Disease Related Questionnaire and the Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires to study members. They received 45 replies from the 222 dermatitis herpetiformis patients, and 35 replies from the 129 celiac disease control subjects. All patients had experienced at least one fracture. 

Overall, cumulative lifetime fracture rates were about the same for both dermatitis herpetiformis and celiac disease patients. 

Fractures More Common in Women with Celiac Disease

However, when the team looked at the cumulative incidence of fracture after disease diagnosis, they found a significantly higher risk in women with celiac disease than in women with dermatitis herpetiformis. 

Acid Reflux and Proton-Pump Inhibitor Connection

Interestingly, both dermatitis herpetiformis and celiac disease patients with fractures reported more severe reflux symptoms compared to those without. Dermatitis herpetiformis and celiac disease patients with fractures also reported using more proton-pump inhibitor medication. More research needs to be done to explore this connection.

To sum it up, self-reported lifetime bone fracture risk is about the same for both DH and celiac disease patients. However, after diagnosis, fracture risk is higher in women with celiac disease than in women with dermatitis herpetiformis.

This means that women with celiac disease need to work with doctors to keep a tight eye on bone integrity, even when eating a gluten-free diet.

Source:

•  Nutrients. 2018 Mar 14;10(3). pii: E351. doi: 10.3390/nu10030351

Celiac.com 11/07/2018 - A team of researchers recently set out to explore the relationship between dermatitis herpetiformis, as a common extraintestinal manifestation of celiac disease, and a gluten-free diet as a path to overall dermatitis herpetiformis improvement.

The research team included Timo Reunala, Teea T. Salmi, Kaisa Hervonen, Katri Kaukinen and Pekka Collin. They are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Life Sciences at the University of Tampere, the Department of Dermatology, Tampere University Hospital, the Department of Internal Medicine, Tampere University Hospital, and with the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital in Tampere, Finland.

Dermatitis herpetiformis is a condition marked by itchy papules and vesicles on the elbows, knees, and buttocks. Dermatitis herpetiformis is a common in people with celiac disease.

People who have just dermatitis herpetiformis alone rarely have obvious gastrointestinal symptoms. Dermatitis herpetiformis is easily diagnosed by immunofluorescence biopsy showing pathognomonic granular immunoglobulin A (IgA) deposits in the papillary dermis. 

One theory currently in play is that dermatitis herpetiformis is triggered by celiac disease in the gut and eventually develops into an immune complex deposition of high avidity IgA epidermal transglutaminase (TG3) antibodies, together with the TG3 enzyme, in the papillary dermis. 

The age at which people are diagnosed with dermatitis herpetiformis has risen steeply in recent decades to the current average of 40–50 years. 

The researchers found that the ratio of dermatitis herpetiformis to celiac disease is 1:8 in Finland and the United Kingdom (U.K.). Additionally, the incident rates of dermatitis herpetiformis are currently 2.7 per 100,000 in Finland and 0.8 per 100,000 in the U.K., is decreasing, whereas incidents of celiac disease are on the rise. 

One positive finding is that Dermatitis herpetiformis patients who are on a gluten-free diet face an excellent long-term outlook, with an even lower mortality rate than the general population.

Read more in: Nutrients 2018, 10(5), 602; doi:10.3390/nu10050602

Celiac.com 03/06/2017 - Dermatitis herpetiformis is an autoimmune skin-blistering disease which is commonly associated with celiac disease. The most common treatments are a gluten-free diet along with the addition of dapsone. DH that does not respond to either a gluten-free diet, or to dapsone, is treated with other immune-suppressing medications, but results have been mixed.

Now, for the first time, a patient treated with rituximab therapy had resolution of both his pruritus and skin rash. "In addition, the levels of both anti-tissue and anti-epidermal transglutaminase antibodies normalized," said Dr. Ron Feldman of Emory University School of Medicine.

Writing in JAMA Dermatology, Dr. Feldman and colleagues describe a man in his 80's with a five-year history of worsening DH. He was put on a gluten-free diet along with dapsone 50 mg daily, but his pruritic rash persisted. Dapsone was discontinued because of worsening anemia. He began treatment with 3 g sulfasalazine daily, but this was discontinued due to gastrointestinal symptoms. His disease worsened, and he was put on a tapering course of prednisone from 40 mg to 10 mg daily along with azathioprine titrated up to 2.5 mg/kg daily. However, his disease continued to worsen over subsequent months.

He was then treated with rituximab according to the protocol used to treat lymphoma: four weekly infusions of 375 mg/m2. "Rituximab," says Dr. Feldman, "has already shown efficacy in the treatment of other autoimmune blistering diseases such as pemphigus and pemphigoid and may have relevance with other B cell mediated diseases in dermatology."

Thirteen months after treatment, the patient experienced complete resolution of pruritus and other symptoms of DH, as well as normalization of antibodies against both epidermal and tissue transglutaminases.

Not only was there a normalization of antibodies against both epidermal and tissue transglutaminases, the patient went into remission and has remained symptom-free for up to a year and a half thus far, said Dr. Feldman.

There is some cause for excitement here, since rituximab is well tolerated and can potentially provide long lasting remission with removal of pathogenic autoimmune B cells.

Dr. Feldman concedes that their patient did not have serious gastrointestinal symptoms, but remains "hopeful that rituximab may provide similar benefits for patients with celiac disease, in which anti-tissue transglutaminase antibodies play a role, although further research will need to be done to confirm this."

Source:

• JAMA Dermatology, online December 28, 2016

Celiac.com 02/20/2017 - Nickel is the most common cause of contact allergy, and nickel exposure can result in systemic nickel allergy syndrome, which mimics irritable bowel syndrome (IBS). Nickel is also found in wheat, which invites questions about possible nickel exposure from wheat in some cases of contact dermatitis. However, nickel hasn't really been studied in relation to glutenâ€related diseases.

A research team recently set out to evaluate the frequency of contact dermatitis due to nickel allergy in NCWS patients diagnosed by a doubleâ€blind placeboâ€controlled(DBPC) challenge, and to identify the characteristics of NCWS patients with nickel allergy. The research team included Alberto D'Alcamo, Pasquale Mansueto, Maurizio Soresi, Rosario Iacobucci, Francesco La Blasca, Girolamo Geraci, Francesca Cavataio, Francesca Fayer, Andrea Arini, Laura Di Stefano, Giuseppe Iacono, Liana Bosco, and Antonio Carroccio.

The are variously affiliated with the Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo, Italy; the Surgery Department, University Hospital, Palermo, Italy; Pediatric Unit, "Giovanni Paolo II" Hospital, Sciacca (ASP Agrigento), Italy; DiBiMIS, Gastroenterology Unit, University Hospital, Palermo, Italy; Pediatric Gastroenterology Unit, "ARNAS Di Cristina" Hospital, Palermo, Italy; Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (Ste.Bi.CeF), University of Palermo, Palermo, Italy.

Their team conducted a prospective study of 54 women and 6 men, with an average age of 34.1 year, and diagnosed with NCWS from December 2014 to November 2016. They also included a control group of 80 age†and sexâ€matched subjects with functional gastrointestinal symptoms.

Patients reporting contact dermatitis related to nickelâ€containing objects were given a nickel patch sensitivity test. The tests showed that six out of sixty patients (10%) with NCWS suffered from contact dermatitis and nickel allergy, and this frequency was statistically higher than observed in the 5 percent seen in the control group.

Compared to NCWS patients who did not suffer from nickel allergy, NCWS patients with nickel allergy commonly showed a higher rates of skin symptoms after wheat consumption. Contact dermatitis and nickel allergy are more frequent in NCWS patients than in subjects with functional gastrointestinal disorders.

Moreover, large numbers of these patients showed cutaneous manifestations after wheat ingestion. Nickel allergy should be evaluated in NCWS patients who have cutaneous manifestations after wheat ingestion.

More study is needed to determine the relationship between nickel sensitivity and NCWS.

Source:

• Nutrients 2017, 9(2), 103; doi:10.3390/nu9020103

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.

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.

Source:

• Acta Derm Venereol. 2016 Jan;96(1):82-6. doi: 10.2340/00015555-2184.

Celiac.com 04/14/2014 - Exposure to stressful stimuli, such as inflammation, cause cells to up-regulate heat shock proteins (Hsp), which are highly conserved immunomodulatory molecules. Research points to Hsp involvement in numerous autoimmune diseases, including autoimmune bullous diseases and celiac disease.

To better understand the role of Hsp in autoimmune bullous diseases, a research team conducted the first investigation of the humoral autoimmune response to Hsp40, Hsp60, Hsp70, and Hsp90 in patients with dermatitis herpetiformis (DH; n = 26), bullous pemphigoid (BP; n = 23), and pemphigus vulgaris (PV; n = 16), the first representing a cutaneous manifestation of celiac disease.

The research team included Kasperkiewicz M1, Tukaj S, Gembicki AJ, Silló P, Görög A, Zillikens D, Kárpáti S. They are affiliated with the Department of Dermatology at the University of Lübeck in Lübeck, Germany.

In patients with active BP and PV, serum levels of autoantibodies against these Hsp matched the healthy control subjects (n = 9-14), while circulating autoantibodies against Hsp60, Hsp70, and Hsp90 increased at the active disease stage of DH.

Further analysis showed that in patients who adopt a gluten-free diet, these anti-Hsp autoantibodies decreased in relation to serum autoantibodies against epidermal and tissue transglutaminase during remission of skin lesions.

Larger groups of patients must be studied to confirm these findings, but these results indicate that autoantibodies against Hsp60, Hsp70, and Hsp90 play a key role in the development and maintenance of DH, possibly also in the underlying celiac disease, and may be important in
potentially undiscovered disease biomarkers.

Source:

• Open Original Shared Link

People with celiac disease, even with asymptomatic forms, often experience reduced bone density from metabolic bone disease. This led scientists to ask if dermatitis herpetiformis results in bone loss as celiac disease does.

However, there is very little data about bone density in patients with dermatitis herpetiformis, so that question remained unanswered.

To find an answer, a team of researchers recently set out to compare bone mineral density (BMD) of people with celiac disease against bone mineral density for dermatitis herpetiformis patients.

The research team included K. Lorinczy, M. Juhász, M. Csontos, B. Fekete, O. Terjék, P.L. Lakatos, P. Miheller, D. Kocsis, S. Kárpáti, Z. Tulassay, and T. Zágoni.

The team looked at 34 people with celiac disease, 53 with dermatitis herpetiformis, and 42 healthy people as a control group. The average patient age was 38.0 +/- 12.1 for the celiac disease group, 32.18 +/- 14.95 for the dermatitis herpetiformis group, and 35.33 +/- 10.41 years for the healthy control group.

For each group, the team used dual-energy X-ray absorptiometry to measure bone mineral density of the lumbar spine, the left femoral neck and radius.

The team defined low bone density, osteopenia and osteoporosis as a body mass density (BMD) T-score between 0 and -1, between -1 and -2.5, and under -2.5, respectively.

In the lumbar region, the team found decreased BMD in 49% of the patients with dermatitis herpetiformis, in 62% of the patients with celiac disease, and in 29% of healthy control subjects.

Overall, they measured lower BMD at the lumbar region in people with dermatitis herpetiformis and celiac disease than in the healthy subjects (0.993 +/- 0.136 g/cm2 and 0.880 +/- 0.155 g/cm2 vs. 1.056 +/- 0.126 g/cm2; p < 0.01).

There was no difference in density of bones composed of dominantly cortical compartment (femoral neck) in dermatitis herpetiformis and healthy subjects.

This study shows that low bone mass is common in patients with dermatitis herpetiformis, and that bone mineral density for these patients is significantly lower in those bones with more trabecular than cortical composition.

Source:

• Open Original Shared Link

Celiac.com 08/26/2013 - Celiac disease and its cutaneous manifestation, dermatitis herpetiformis are both disease marked by sensitivity to gluten. Metabolic bone disease is common among in people with celiac disease, but there isn't much data on rates of bone density in patients with dermatitis herpetiformis.

A team of researchers recently set out to determine if dermatitis herpetiformis triggers bone loss, as does celiac disease.

The research team included K. Lorinczy, M. Juhász, A. Csontos, B. Fekete, O. Terjék, P.L. Lakatos, P. Miheller, D. Kocsis, S. Kárpáti, Tulassay Z, Zágoni T.

For their study, the team wanted to compare bone mineral density (BMD) of celiac and dermatitis herpetiformis patients.

The study group included 34 celiac patients, 53 with dermatitis herpetiformis and 42 healthy controls.

Average age for celiac patients was 38.0 +/- 12.1 years, for dermatitis herpetiformis it was 32.18 +/- 14.95 years, while it was 35.33 +/- 10.41 years for healthy control subjects.

The team used dual-energy X-ray absorptiometry to measure bone mineral density of the lumbar spine, the left femoral neck and radius.

They defined low bone density, osteopenia and osteoporosis as a body mass density (BMD) T-score between 0 and -1, between -1 and -2.5, and under -2.5, respectively.

They found decreased BMD in the lumbar region, consisting of dominantly trabecular compartment, in 26 patients (49%) with dermatitis herpetiformis, 21 patients with celiac disease (62%), and in 12 of the healthy control subjects (29%).

They also measured lower BMD at the lumbar region in dermatitis herpetiformis and celiac patients, compared to healthy subjects (0.993 +/- 0.136 g/cm2 and 0.880 +/- 0.155 g/cm2 vs. 1.056 +/- 0.126 g/cm2; p < 0.01).

They found no difference in density of bones consisting of dominantly cortical compartment (femoral neck) between dermatitis herpetiformis patients and healthy control subjects.

The results show that a low bone mass is also common in patients with dermatitis herpetiformis. Bone mineral content in these patients is significantly lower in those parts of the skeleton which contain more trabecular bone, and less reduced in areas with more cortical bone.

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