Dermatitis herpetiformis: a cutaneous manifestation of coeliac disease

Figures & data

Figure 1. Dermatitis herpetiformis. (A) Blisters on the elbows and knees. (B) Fresh, small blisters on the elbow. (C) Excoriated blisters and scars on the elbow, a typical clinical picture caused by scratching the lesions.

Figure 2. Immunofluorescence findings in dermatitis herpetiformis. Pathognomonic granular IgA deposits in the basal membrane zone between epidermis and dermis, and also deeper in the dermal tissue.

Table 1. Comparison between dermatitis herpetiformis and coeliac disease.

	Dermatitis herpetiformis	Coeliac disease
Occurrence (clinically diagnosed)	1/1330–3300	1/143–420^a
Incidence½	Decreasing	Increasing
Sex	Slightly more males	Females predominate
Age at onset	Mainly adults	Children and adults
First degree relatives affected with coeliac disease and DH	5.4%	5.5%
IgA-TG3 deposits on the skin	100% (by definition)	0%
Small bowel villous atrophy	73%	100% (by definition)
IgA TG2 deposits in bowel mucosa	79%	100%
IgA TG2 antibodies in serum	86%	92%
IgA TG3 antibodies in serum	86%	24%

TG2 = tissue transglutaminase; TG3 = epidermal transglutaminase.

^a Serologic screening studies have shown a prevalence of more than 1/100.