Dermatitis herpetiformis as a gluten induced extraintestinal manifestation in coeliac disease: retrospective study of patients assisted at "Dr. Manuel Quintela" University Hospital

Introduction: dermatitis herpetiformis (DH) is an inflammatory cutaneous disease comprising relapses and remissions. It is an extraintestinal manifestation of coeliac disease, which can even be its first clinical manifestation. Coeliac disease (CD) is an autoimmune systemic disease, associated with enteropathy, that is induced by the intake of gluten in genetically predisposed individuals. In both diseases an association between HLA DQ2 and HLA DQ8 has been proved. Objective: to present the characteristics of patients with Dermatitis herpetiformis (DH) and Coeliac disease (CD) who are assisted in the dermatology and gastroenterology polyclinics at the "Dr. Manuel Quintela" University Hospital. Methodology: descriptive, observational, retrospective and longitudinal study of a series of cases. Inclusion criteria: patients assisted at the dermatology and gastroenterology services of the University Hospital, with a diagnosis of Dermatitis herpetiformis (DH) confirmed by histopathology and/or direct immunofluorescence (DIF), from July, 200 to June 2018 inclusive. Patients whose skin histopathological exam could not be accessed were excluded from the study. Results: 15 patients were included, 9 male and 6 female. Average age upon diagnosis of DH is 49 years old. 4 patients were treated with dapsona, evidencing a fast response to dermatosis, and no severe adverse effects. In 13 patients, DH was the guiding symptom to diagnose coeliac disease. However, 5 patients had asymptomatic CD, 6 presented classical symptoms and 4 non-classical symptoms.