Guidelines for the management of dermatitis herpetiformis
Keywords:
Dermatitis herpetiformis, guidelines, managementAbstract
Dermatitis herpetiformis is a rare autoimmune bullous disorder characterized by intensely pruritic polymorphic lesions over extensor surfaces of body, associated with gluten sensitive subclinical or clinical enteropathy. Dermatitis herpetiformis is often misdiagnosed and there is a paucity of guidelines for the management of dermatitis herpetiformis in literature. The present guidelines have been prepared for physician and dermatologists. It reflects highest evidence based data available at the time of formulating the guidelines. The diagnosis of dermatitis herpetiformis is made clinically, histologically, immunopathologically and supported by serology. A gluten free diet is the treatment of choice for all patients with dermatitis herpetiformis. Dapsone should be used during the acute presentation until the gluten free diet is effective. In conclusion, the present guidelines provide evidence based guidance for management of dermatitis herpetiformis.References
Collin P, Reunala T. Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists. Am J Clin Dermatol. 2003;4:13-20.
Kárpáti S. Dermatitis herpetiformis: close to unravelling a disease. J Dermatol Sci. 2004;34:83-90.
Junkins-Hopkins JM. Dermatitis herpetiformis: pearls and pitfalls in diagnosis and management. J Am Acad Dermatol. 2010;63:526-8.
Caproni M, Antiga E, Melani L, Fabbri P. The Italian Group for Cutaneous Immunopathology. Guidelines for the diagnosis and treatment of dermatitis herpetiformis. J Eur Acad Dermatol Venereol. 2009;23:633-8.
Reunala TL. Dermatitis herpetiformis. Clin Dermatol. 2001;19:728-36.
Oxentenko AS, Murray JA. Celiac disease and dermatitis herpetiformis: the spectrum of gluten-sensitive enteropathy. Int J Dermatol. 2003;42:585-7.
Suárez-Fernández R, España-Alonso A, Herrero-González J, Mascaró-Galy JM. Practical management of the most common autoimmune bullous diseases. Actas Dermosifiliogr. 2008;99:441-55.
Collin P, Reunala T. Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists. Am J Clin Dermatol. 2003;4:13-20.
Fry L, editor. Dermatitis Herpetiformis. London: Chapman & Hall Medical, 1990.
Dieterich W, Ehnis T, Bauer M et al. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med. 1997;3:797-801.
Schuppan D, Dieterich W, Riecken EO. Exposing gliadin as a tasty food for lymphocytes. Nat Med. 1998;4:666-7.
Molberg O, McAdam SN, Korner R et al. Tissue transglutaminase selectively modifies gliadin peptides that are recognized by gut-derived T cells in celiac disease. Nat Med. 1998;4:713-7.
Anderson RP, Degano P, Godkin AJ et al. In vivo antigen challenge in celiac disease identifies a single transglutaminase-modified peptide as the dominant A-gliadin T-cell epitope. Nat Med. 2000;6:337-42.
Lorand L, Graham RM. Transglutaminases: crosslinking enzymes with pleiotropic functions. Nat Rev Mol Cell Biol. 2003;4:140-56.
Hitomi K. Transglutaminases in skin epidermis. Eur J Dermatol. 2005;15:313-9.
Leonard J, Haffenden G, Tucker W et al. Gluten challenge in dermatitis herpetiformis. N Engl J Med. 1983;308:816-9.
Zone JJ. Skin manifestations of celiac disease. Gastroenterology. 2005;128 (4 suppl. 1):S87-91.
Marks R, Jones EW. Purpura in dermatitis herpetiformis. Br J Dermatol. 1971;84:386-8.
McCleskey PE, Erickson QL, David-Bajar KM, Elston DM. Palmar petechiae in dermatitis herpetiformis: a case report and clinical review. Cutis. 2002;70:217-23.
McGovern TW, Bennion SD. Palmar purpura: an atypical presentation of childhood dermatitis herpetiformis. Pediatr Dermatol. 1994;11:319-22.
Pierce DK, Purcell SM, Spielvogel RL. Purpuric papules and vesicles of the palms in dermatitis herpetiformis. J Am Acad Dermatol. 1987;16:1274-6.
Hofmann SC, Nashan D, Bruckner-Tuderman L. Petechiae on the fingertips as presenting symptom of dermatitis herpetiformis Duhring. J Eur Acad Dermatol Venereol. 2009;23:732-3.
Nicolas ME, Krause PK, Gibson LE, Murray JA. Dermatitis herpetiformis. Int J Dermatol. 2003;42:588-600.
Lahteenoja H, Toivanen A, Viander M et al. Oral mucosal changes in coeliac patients on a gluten-free diet. Eur J Oral Sci. 1998;106:899-906.
Campisi G, Di Liberto C, Iacono G et al. Oral pathology in untreated celiac disease. Aliment Pharmacol Ther. 2007;26:1529-36.
Aine L, Maki M, Reunala T. Coeliac-type dental enamel defects in patients with dermatitis herpetiformis. Acta Derm Venereol. 1992;72:25-7.
Aine L, Reunala T, Maki M. Dental enamel defects in children with dermatitis herpetiformis. J Pediatr. 1991;118:572-4.
Suárez-Fernández R, España-Alonso A, Herrero-González J, Mascaró-Galy JM. Practical management of the most common autoimmune bullous diseases. Actas Dermosifiliogr. 2008;99:441-55.
Alonso-Llamazares J, Gibson LE, Rogers RS. Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: review of the Mayo Clinic experience. Int J Dermatol. 2007;46:910-9.
Caproni M, Antiga E, Melani L, Fabbri P. The Italian Group for Cutaneous Immunopathology. Guidelines for the diagnosis and treatment of dermatitis herpetiformis. J Eur Acad Dermatol Venereol. 2009;23:633-8.
Stamnaes J, Dorum S, Fleckenstein B et al. Gluten T cell epitope targeting by TG3 and TG6; implications for dermatitis herpetiformis and gluten ataxia. Amino Acids. 2010;39:1183-91
Caproni M, Antiga E, Melani L, Fabbri P. Guidelines for the diagnosis and treatment of dermatitis herpetiformis. J Eur Acad Dermatol Venereol. 2009;23:633-8.
Loviselli A, Velluzzi F, Mossa P et al. The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in Sardinian schoolchildren: relationship to goiter prevalence and thyroid function. Thyroid. 2001;11:849-57.
Fry L, McMinn RM, Cowan JD, Hoffbrand AV. Gluten-free diet and reintroduction of gluten in dermatitis herpetiformis. Arch Dermatol. 1969;100:129-3
Kilander AF, Gillberg RE, Kastrup W et al. Serum antibodies to gliadin and small intestinal morphology in dermatitis herpetiformis. A controlled clinical study of the effect of treatment with a gluten-free diet. Scand J Gastroenterol. 1985;20:951-8.
Fry L, Seah PP, Riches DJ, Hoffbrand AV. Clearance of skin lesions in dermatitis herpetiformis after gluten withdrawal. Lancet. 1973;1:288-91.
Reunala T, Blomqvist K, Tarpila S et al. Gluten free diet in dermatitis herpetiformis. I. Clinical response of skin lesions in 81 patients. Br J Dermatol. 1977;97:473-80.
Hardman CM, Garioch J, Leonard JN et al. Absence of toxicity of oats in patients with dermatitis herpetiformis. N Engl J Med. 1997;337:1884-7.
Garioch JJ, Lewis H, Sargent SA et al. 25 years’ experience of a gluten-free diet in the treatment of dermatitis herpetiformis. Br J Dermatol. 1994;131:541-5.
Rottmann LH. Details of the gluten-free diet for the patients with dermatitis herpetiformis. Clin Dermatol. 1992;9:409-414.
Wolverton SE, editor. Comprehensive Dermatologic Drug Therapy. Philadelphia: Saunders Elsevier; 2007.
Mery L, Dega H, Prost C, Dubertret L. Dapsone-induced sensory peripheral neuropathy. Ann Dermatol Venereol. 2003;130:447-9.
Swerdlow AJ, Whittaker S, Carpenter LM, English JSC. Mortality and cancer incidence in patients with dermatitis herpetiformis: a cohort study. Br J Dermatol. 1993;129:140-4.