Recent Studies in Dermatitis Herpetiformis - A Lecture Given by Dr. Lionel Fry

The following are excerpts from a lecture given by Dr Lionel Fry at the 1984 AGM in London. Dr. Fry is a consultant dermatologist. The lecture is entitled: Recent Studies in Dermatitis Herpetiformis.

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..we have looked at the records of 78 patients who have been attending our special DH clinic. The length of follow-up of these patients has ranged from 3 to 14 years (mean 7.4). All patients were offered a gluten-free diet as part of their treatment. However, only 42 patients have taken the diet......in only 23 patients was the diet absolutely strict, in another 17 there had been very occasional, but unintentional gluten intake, and in 2 there had been occasional but intentional intake. When these three groups of patients are compared it has been found that of the 23 patients taking a strict diet, 22 (96%) were able to stop drugs compared to 8 (47%) of 17 patients who had occasional but unintentional gluten (the 2 occasional but intentional gluten eaters could not stop drugs)........One of the most significant points to have emerged from our study is the time it takes with a gluten free diet before patients may reduce the dose of their drugs to control the rash, and eventually cease to need drugs. The mean time before there was a reduction in the dose of dapsone was 4-30 months (mean 8), and 6-108 months (mean 29 ) before the drugs were no longer required. These times were dependent on the strictness of the diet. ....In the past many doctors have been unaware that it has taken so long before the drugs could be reduced or stopped and this led to a situation where it was thought that the rash was not due to gluten.......Twelve of our patients agreed to take gluten again to see if their rash returned. These 12 patients had been on a gluten free diet for periods ranging from 3-12 years (mean 7.5). In 11 of the 12 patients the rash recurred in times ranging from 2-36 weeks (mean 12). It could be argued that in the patient whose rash did not recur had undergone spontaneous remission........ (sections of the text of a talk by Dr. Lionel Fry, Consultant Dermatologist, St Marys Hospital, London W2).