DH biopsy

[weebl]

About two weeks in to my gluten challenge. I guess you could say it's going well. 

It has gotten easier psychologically to eat foods containing gluten, and I have managed to include significant gluten in each meal, each day. 

Reaction in terms of my suspected DH has been as expected, and the rash and itchiness is back in full force. 

Some Googling seems to indicate that the ATTG blood test in this province actually contains most if not all of the full Celiac panel. So that is good. But I also know with DH, I will still likely test negative. 

I have a December appointment booked with my family doctor. I plan on going to the lab for blood work 1 week prior (and plan to stay on gluten until after I see my doctor). 

I also requested that I have a biopsy done and this is where I need help. 

Those who have had it, is it always a punch biopsy? Is there an authoritative source online I can print off regarding the proper procedure to my doctor? (I suspect he will have already looked into that, but I don't want to leave it to chance). 

Lastly, once my appointment is done, do I go gluten-free again at that point or should I wait for the biopsy? Assuming of course the blood work didn't come back positive, in which case the biopsy will be unnecessary. 

 

[squirmingitch]

https://celiac.org/about-celiac-disease/related-conditions/dermatitis-herpetiformis/

I would also print this out & bring it b/c the diagnostic criteria in regards to dh & celiac changed in 2012. Since then, all that is required is a positive dh biopsy -- no further testing is needed.

http://www.cureceliacdisease.org/faq/can-a-skin-biopsy-for-dermatitis-herpetiformis-dh-confirm-celiac-disease-or-is-an-endoscopy-still-needed/

 

[squirmingitch]

BTW, you don't have to kill yourself with gluten. A bowl of pasta or a slice of bread or a couple of crackers each day is enough. You don't have to eat gluten at every meal. Remember, every time you eat gluten, those antibodies are being deposited under your skin. Once there, they are like little grenades just sitting until something triggers them to explode so don't eat any more gluten than what it takes to get the job done.

Also, you could read this for when the time comes & you go gluten free again. The Newbie 101 which is pinned to the top of the Coping section. This will help you to stay safe, explain what kitchen items you need to replace & which you don't. 

[weebl]

Thanks. Anxiously awaiting my appointment now. 

[squirmingitch]

On 11/21/2018 at 6:50 PM, weebl said:

Lastly, once my appointment is done, do I go gluten-free again at that point or should I wait for the biopsy? Assuming of course the blood work didn't come back positive, in which case the biopsy will be unnecessary. 

 

Sorry, I missed answering your last question there. Keep eating gluten until the biopsy is done. 

Hang in there!

[Jacki Espo]

Can anyone share a source that you must be eating gluten for the skin punch biopsy to be useful? My derm disagreed with me.  Did the biopsy and of course it came back negative bc I have been gluten free since Dec. 

Can anyone direct me to a source? Thanks.

[trents]

It's just logical. DH is the epidermal expression of celiac disease. No gluten, no inflammation and so no antibodies.

[Wheatwacked]

A skin biopsy is the first step in diagnosing DH. Direct immunofluorescence of clinically normal skin adjacent to a lesion shows granular IgA deposits in the upper dermis. Histology of lesional skin may show microabscesses containing neutrophils and eosinophils. However, histology may reveal only excoriation due to the intense itching that patients experience.  https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/digestive-diseases/dermatitis-herpetiformis

The key here is the biopsy has to be adjacent to a lesion, not the lesion itself. Has your dermatologist diagnosed other cases of DH? In the end if GFD relieves the symptoms do you care what the doctors think?

Dermatitis Herpetiformis: An Update on Diagnosis and Management IgA deposits persist in the dermis for at least a few years after adherence to a GFD, so the DH diagnosis can be confirmed afterwards without returning to a normal gluten-containing diet if necessary.

[Jacki Espo]

3 hours ago, Wheatwacked said:

I couldn't agree more.  My body is not going near gluten ever again. The only reason I'm on this search at this stage is to ensure it's not something else happening that I'm missing in my body.  My dermatologist did take skin adjacent to a lesion but he was adamant and I did not need to be eating gluten for the test to be accurate. 

15 hours ago, trents said:

It's just logical. DH is the epidermal expression of celiac disease. No gluten, no inflammation and so no antibodies.