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. 1977 Oct;30(10):976–980. doi: 10.1136/jcp.30.10.976

Dermatitis herpetiformis: a comparative assessment of skin and bowel abnormality.

T Cooney, C T Doyle, D Buckley, M J Whelton
PMCID: PMC476607  PMID: 591635

Abstract

We reviewed 18 patients with a clinical diagnosis of dermatitis herpetiformis who were being treated with dapsone and were on an unrestricted diet. Diagnosis was confirmed by finding IgA deposits in the dermal papillae of unaffected skin. Dapsone was discontinued and biopsy of affected skin was carried out when the typical rash reappeared. The biopsy findings were graded according to the severity of the histological changes. Small bowel tissue from each patient was examined and graded by stereo- and routine microscopy. Thirteen specimens (72%) were stereomicroscopically abnormal; all 18 showed villous atrophy, either partial or subtotal; and in 13 (72%) the interepithelial lymphocyte count was increased. No correlation was found between the histological severity of the skin and the small bowel lesions. Seemingly the severity of the skin rash in dermatitis herpetiformis is no guide to the degree of small bowel abnormality.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brow J. R., Parker F., Weinstein W. M., Rubin C. E. The small intestinal mucosa in dermatitis herpetiformis. I. Severity and distribution of the small intestinal lesion and associated malabsorption. Gastroenterology. 1971 Mar;60(3):355–361. [PubMed] [Google Scholar]
  2. Connor B. L., Marks R., Jones E. W. Dermatitis herpetiformis: histological discriminants. Trans St Johns Hosp Dermatol Soc. 1972;58(2):191–198. [PubMed] [Google Scholar]
  3. Ferguson A., Murray D. Quantitation of intraepithelial lymphocytes in human jejunum. Gut. 1971 Dec;12(12):988–994. doi: 10.1136/gut.12.12.988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fry L., Keir P., McMinn R. M., Cowan J. D., Hoffbrand A. V. Small-intestinal structure and function and haematological changes in dermatitis herpetiformis. Lancet. 1967 Oct 7;2(7519):729–733. doi: 10.1016/s0140-6736(67)91942-3. [DOI] [PubMed] [Google Scholar]
  5. Fry L., McMinn R. M., Cowan J. D., Hoffbrand A. V. Effect of gluten-free diet on dermatological, intestinal, and haematological manifestations of dermatitis herpetiformis. Lancet. 1968 Mar 16;1(7542):557–561. doi: 10.1016/s0140-6736(68)92830-4. [DOI] [PubMed] [Google Scholar]
  6. Fry L., McMinn R. M., Cowan J. D., Hoffbrand A. V. Gluten-free diet and reintroduction of gluten in dermatitis herpetiformis. Arch Dermatol. 1969 Aug;100(2):129–135. [PubMed] [Google Scholar]
  7. Fry L., Seah P. P. Dermatitis herpetiformis: an evaluation of diagnostic criteria. Br J Dermatol. 1974 Feb;90(2):137–146. doi: 10.1111/j.1365-2133.1974.tb06377.x. [DOI] [PubMed] [Google Scholar]
  8. Fry L., Seah P. P., Harper P. G., Hoffbrand A. V., McMinn R. M. The small intestine in dermatitis herpetiformis. J Clin Pathol. 1974 Oct;27(10):817–824. doi: 10.1136/jcp.27.10.817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fry L., Seah P. P., McMinn R. M., Hoffbrand A. V. Lymphocytic infiltration of epithelium in diagnosis of gluten-sensitive enteropathy. Br Med J. 1972 Aug 12;3(5823):371–374. doi: 10.1136/bmj.3.5823.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Heading R. C., Paterson W. D., McClelland D. B., Barnetson R. S., Murray M. S. Clinical response of dermatitis herpetiformis skin lesions to a gluten-free diet. Br J Dermatol. 1976 May;94(5):509–514. doi: 10.1111/j.1365-2133.1976.tb05138.x. [DOI] [PubMed] [Google Scholar]
  11. Holmes G. K., Stokes P. L., Sorahan T. M., Prior P., Waterhouse J. A., Cooke W. T. Coeliac disease, gluten-free diet, and malignancy. Gut. 1976 Aug;17(8):612–619. doi: 10.1136/gut.17.8.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Marks R., Whittle M. W. Results of treatment of dermatitis herpetiformis with a gluten-free diet after one year. Br Med J. 1969 Dec 27;4(5686):772–775. doi: 10.1136/bmj.4.5686.772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mavromichalis J., Brueton M. J., McNeish A. S., Anderson C. M. Evaluation of the intraepithelial lymphocyte count in the jejunum in childhood enteropathies. Gut. 1976 Aug;17(8):600–603. doi: 10.1136/gut.17.8.600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mylotte M., Egan-Mitchell B., McCarthy C. F., McNicholl B. Incidence of coeliac disease in the West of Ireland. Br Med J. 1973 Mar 24;1(5855):703–705. doi: 10.1136/bmj.1.5855.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. PIERARD J., WHIMSTER I. The histological diagnosis of dermatitis herpetiformis, bullous pemphigoid and erythema multifore. Br J Dermatol. 1961 Jul;73:253–266. doi: 10.1111/j.1365-2133.1961.tb14442.x. [DOI] [PubMed] [Google Scholar]
  16. Ruppin H., Weidner F., Domschke S., Domschke W., Classen M., Hornstein O. P. Dermatitis herpetiformis and small intestinal lesion--no strict association in german patients. Acta Hepatogastroenterol (Stuttg) 1975 Apr;22(2):105–111. [PubMed] [Google Scholar]
  17. Scott B. B., Losowsky M. S. Proceedings: Patchiness of the mucosal abnormality in coeliac disease (CD) and dermatitis herpetiformis (DH). Gut. 1975 May;16(5):393–393. [PubMed] [Google Scholar]
  18. Scott B. B., Young S., Rajah S. M., Marks J., Losowsky M. S. Coeliac disease and dermatitis herpetiformis: further studies of their relationship. Gut. 1976 Oct;17(10):759–762. doi: 10.1136/gut.17.10.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Seah P. P., Fry L. Immunoglobulins in the skin in dermatitis herpetiformis and their relevance in diagnosis. Br J Dermatol. 1975 Feb;92(2):157–166. doi: 10.1111/j.1365-2133.1975.tb03052.x. [DOI] [PubMed] [Google Scholar]
  20. Shuster S., Watson A. J., Marks J. Coeliac syndrome in dermatitis herpetiformis. Lancet. 1968 May 25;1(7552):1101–1106. doi: 10.1016/s0140-6736(68)90181-5. [DOI] [PubMed] [Google Scholar]
  21. Stevens F. M., Lloyd R., Egan-Mitchell B., Mylotte M. J., Fottrell P. F., Wright R., McNicholl B., McCarthy C. F. Reticulin antibodies in patients with coeliac disease and their relatives. Gut. 1975 Aug;16(8):598–602. doi: 10.1136/gut.16.8.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Weinstein W. M., Brow J. R., Parker F., Rubin C. E. The small intestinal mucosa in dermatitis herpetiformis. II. Relationship of the small intestinal lesion to gluten. Gastroenterology. 1971 Mar;60(3):362–369. [PubMed] [Google Scholar]

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