THE MANAGEMENT OF DERMATITIS HERPETIFORMIS BY THE GASTROENTEROLOGIST. A SERIES OF CASES

• Published in: Arquivos de gastroenterologia 2021-10, Vol.58 (4), p.429-432
• Main Authors: Kotze, Lorete Maria da Silva, Kotze, Luiz Roberto, Purim, Katia Sheylla Malta, Nisihara, Renato
• Format: Article
• Language: English
• Subjects: Adult; Celiac Disease; complaints; Dermatitis herpetiformis; Dermatitis Herpetiformis - drug therapy; Diet, Gluten-Free; Female; Gastroenterologists; GASTROENTEROLOGY & HEPATOLOGY; Humans; Male; Retrospective Studies; treatment
• ISSN: 0004-2803; 1678-4219; 1678-4219
• DOI: 10.1590/S0004-2803.202100000-78

Dermatitis herpetiformis (DH) is considered a skin celiac disease (CD). The individuals can be seen by primary care professionals or by dermatologists that could refer the patient to a gastroenterologist. The study aimed to investigate the clinical profile of patients diagnosed with DH and referred to a gastroenterologist and evaluate the treatment response. We retrospectively studied patients with DH referred to the same gastroenterologist at a private office in Curitiba, Brazil, between January 2010 to December 2019. We included adult patients with a confirmed DH diagnosis. Symptoms, clinical signs, laboratory and histological data, as well as treatment response, were collected. Thirty-three patients were studied (60.6% women, mean age at diagnosis 40.8±12.61 years). The median delay for DH diagnosis was four years. Skin involvement was mild in 33.3%, moderate in 18.2%, and severe in 48.5%. The more frequent gastrointestinal complaints were abdominal distension (78.8%), flatulence (75.7%), and gastroesophageal reflux (51.5%). Depression and anxiety were observed in 81.8% and anemia in 51.1%. A higher prevalence of bone disorders was associated with higher age at DH diagnosis (P=0.035). Duodenal biopsy showed changes in all patients. Improvement after treatment only with a gluten-free diet (GFD) plus dapsone was verified in 81.2%. Patients with DH referred to a gastroenterologist showed a high frequency of gluten intolerance and systemic complaints. Duodenal histological alterations were found in all the cases. The treatment based on GFD plus dapsone was effective in most patients.