ABSTRACT
Dermatitis herpetiformis is an autoimmune chronic blistering disease, considered a skin manifestation of celiac disease. Being both conditions multifactorial, they share some genetic traits and pathogenic mechanisms, which are responsible for the typical skin and gastrointestinal manifestations. In dermatitis herpetiformis, skin and other lesions heal after gluten-free diet and reappear shortly after its reintroduction to complete diet. Prevalence of celiac disease is 1% in the population, and approximately 13% of patients with the disease develop dermatitis herpetiformis. Diagnosis of celiac disease has progressively increased in recent decades, while clinical manifestations become more and more diverse. Given the current high frequency of skin lesions in celiac patients, in this review we update relevant aspects of the epidemiology, pathogenesis, clinical presentations, treatment and follow up of dermatitis herpetiformis, as a contribution to improve the management of both conditions.
Subject(s)
Humans , Celiac Disease/complications , Celiac Disease/diagnosis , Dermatitis Herpetiformis/diagnosis , Dermatitis Herpetiformis/etiology , SkinABSTRACT
Researches on DH have shown that it is not just a bullous skin disease, but a cutaneous-intestinal disorder caused by hypersensitivity to gluten. Exposure to gluten is the starting point of an inflammatory cascade capable of forming autoantibodies that are brought to the skin, where they are deposited, culminating in the formation of skin lesions. These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur. Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative. Patients who follow glutenfree diets have better control of symptoms on the skin and intestine, as well as lower risks of progression to lymphoma. Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.
Subject(s)
Female , Humans , Male , Dermatitis Herpetiformis/pathology , Dermatitis Herpetiformis/therapy , Celiac Disease/etiology , Celiac Disease/pathology , Celiac Disease/therapy , Diet, Gluten-Free , Dapsone/therapeutic use , Dermatitis Herpetiformis/etiology , Fluorescent Antibody Technique, Direct , Folic Acid Antagonists/therapeutic use , Skin/pathologyABSTRACT
An allergenic protein fraction was isolated from wheat gluten by ion exchange and gel filtration chromatography. On sodium dodecyl sulphate gel electrophoresis the molecular mass of the protein was found to be 65 kDa. By Western blotting it was confirmed that the 65 kDa protein was the major allergenic fraction causing dermatitis herpetiformis (DH) and it contained glutamic acid and proline as the major amino acids.
Subject(s)
Allergens/chemistry , Amino Acids/analysis , Chromatography , Dermatitis Herpetiformis/etiology , Electrophoresis, Polyacrylamide Gel , Glutens/chemistry , Plant Proteins/chemistry , Triticum/immunologyABSTRACT
A dermatite herpetiforme é uma doença bolhosa crônica, sensível ao glúten, relacionada a us risco aumentado para o desenvolvimento de linfoma. Através deste artigo, foi realizada uma revisão bibliográfica sobre seus aspectos epidemiológicos clínicos e terapêuticos.
Dermatitis herpetiformis is a lifelong, gluten sensitive skin disease, that is associated with an increased risk for lymphoma. It was made a bibliographic review about its epidemiological, clinical and therapeutical features.