Gluten intolerance and skin diseases.
ABSTRACT Gluten sensitivity with or without coeliac disease (CD) symptoms and intestinal pathology has been suggested as a potentially treatable cause of various diseases. CD is a chronic disease which improves on withdrawal of wheat gliadins and barley, rye and oat prolamins from the diet. There have been numerous reports linking CD with several skin conditions. A body of evidence shows that dermatitis herpetiformis is actually a cutaneous manifestation of CD. Autoimmune diseases, allergic diseases, psoriasis and miscellaneous diseases have also been described with gluten intolerance. Dermatologists should be familiar with the appraisal of gluten sensitive enteropathy and should be able to search for an underlying gluten intolerance (GI). Serological screening by means of antigliadin, antiendomysial and transglutaminase antibodies should be performed. HLA typing is often useful in association with serologic tests. Intestinal biopsy is usually needed to establish the diagnosis of CD or GI. Thus, gluten intolerance gives rise to a variety of dermatological manifestations which may benefit from a gluten-free diet.
International journal of dermatology 03/2014; 53(7). DOI:10.1111/ijd.12350 · 1.23 Impact Factor
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ABSTRACT: Pyoderma gangrenosum is an inflammatory neutrophilic dermatosis characterized by painful cutaneous ulcerations and often associated with systemic inflammatory and neoplastic diseases. Here we report the first case of pyoderma gangrenosum in a patient with refractory celiac disease. A 52-year-old woman with a previously diagnosed refractory celiac disease resistant to steroids and immunosuppressive drugs presented to our hospital for a rapidly growing, painful inflammatory skin lesion of the left leg. Physical examination revealed a painful lesion with focal ulceration, necrosis and pus discharge with active inflammatory borders at the external part of the left leg. Histological evaluation of a skin biopsy and analysis of inflammatory cytokines and matrix-degrading proteases in lesional skin samples confirmed the clinical suspicion of pyoderma gangrenosum. Treatment with oral prednisone was rapidly followed by a complete healing of the skin lesion but no improvement of symptoms/signs of malabsorption. Treatment of the patient with systemic steroids healed the skin lesion without improving the underlying refractory celiac disease. This observation raises the possibility that refractory celiac disease and pyoderma gangrenosum may be immunologically different.BMC Gastroenterology 11/2013; 13(1):162. DOI:10.1186/1471-230X-13-162 · 2.11 Impact Factor
Article: Dermatitis herpetiforme[Show abstract] [Hide abstract]
ABSTRACT: La dermatitis herpetiforme es una dermatosis vesiculoampollosa de origen autoinmunitario asociada a una enteropatía por gluten. Forma parte de las dermatosis ampollosas autoinmunitarias de la unión dermoepidérmica con depósitos de inmunoglobulinas A (IgA). Su diana antigénica tiene la particularidad de ser una enzima: la transglutaminasa epidérmica. El diagnóstico puede confirmarse por inmunofluorescencia cutánea directa o mediante pruebas serológicas, sobre todo con la búsqueda de IgA antitransglutaminasa tisular y antiendomisio. El tratamiento de base (régimen sin gluten y dapsona) posibilita la remisión cutánea y digestiva y, además, reduce el riesgo de evolución linfomatosa a largo plazo.01/2011; 45(3):1–8. DOI:10.1016/S1761-2896(11)71079-2