Camilla Pasternack, Kaisa Hervonen, Eriika Mansikka, Timo Reunala, Pekka Collin, Katri Kaukinen, Teea Salmi
DOI: 10.2340/00015555-3914

Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a gluten-free diet. However, the itching and blistering rash alleviates slowly after gluten withdrawal and occasionally persists despite a long-term gluten-free diet. This study investigated the prevalence and factors associated with prolonged (i.e. >2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of gluten-free diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms.

Dermatitis herpetiformis is a blistering and itching skin disease and a skin manifestation of coeliac disease. Dermatitis herpetiformis is treated with a life-long gluten-free diet. This study showed that more than one-third of patients with dermatitis herpetiformis on a gluten-free diet have skin symptoms 2 years after being diagnosed, and 14% after long-term dietary treatment. More severe rash at diagnosis was associated with the persistence of skin symptoms, and those having skin symptoms despite a long-term gluten-free diet had a shorter duration and more lapses on their diet. This study emphasizes the importance of a strict and long-lasting gluten-free diet for patients with dermatitis herpetiformis.