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At least 289 records · Page 16Linked to original sources
PubMed1977

Dermatitis herpetiformis: effect of gluten-free diet on skin IgA and jejunal structure and function.

To clarify the controversy about the effectiveness of a gluten-free diet in dermatitis herpetiformis, 10 highly motivated patients were investigated. The indices used to assess improvement included deposition of sub-epidermal IgA in unaffected skin, counts of intraepithelial lymphocytes, deposition of IgA in jejunal villi, and electrical tests of glucose absorption. In every patient subepidermal IgA concentrations fell after gluten withdrawal. In all but one patient the dose of dapsone necessary to control symptoms was reduced. Indeed, six patients stopped taking the drug completely within a year. In nine patients biopsy specimens were taken from the jejunum; seven showed abnormalities in jejunal morphology, eight had increased numbers of intraepithelial lymphocytes, and five had increased numbers of IgA-reactive cells in the lamina propria. Two of these three indices improved after gluten withdrawal, which confirmed that all nine patients were adhering to their diet. Routine screening for malabsorption proved to be unsatisfactory for showing the mild jejunal disease found in patients with dermatitis herpetiformis. The electrical test of glucose absorption showed subnormal results in all eight patients tested, however, and in six the results improved after gluten withdrawal.

Adult↗
PubMed1976

Oral acantholytic itching disease responding to dapsone. Dermatitis herpetiformis, pemphigus, or a new disease?

A patient had a blistering and severely itching disease confined solely to the oral cavity. The histopathologic findings had the features of both pemphigus and dermatitis herpetiformis. There were no gastrointestinal symptoms, no IgA could be found in uninvolved skin, and no intercellular or basement membrane antibodies were present in the serum or epidermis. The disease responded favorable to dapsone (diaminodiphenylsulfone), which could be discontinued after 2 1/2 years. The literature is briefly reviewed, and there is a discussion of whether the patient was suffering from pemphigus or dermatitis herpetiformis. The conclusion is drawn that the diagnosis cannot be established with certainty and that we are perhaps dealing with a new disease. It is stressed that in such aberrant cases a therapeutic trial with dapsone should be made.

Acantholysis↗
PubMed2006

[Dermatitis herpetiformis. A clinical chameleon].

Celiac disease is a genetically determined bowel disease also influenced by exogenous factors in which exposure to grain components triggers a chronic immune response with intestinal symptoms. Dermatitis herpetiformis represents the cutaneous manifestation of celiac disease. While intense pruritus is the characteristic symptom, clinical signs can be highly variable, ranging from grouped papulovesicles with excoriations or eczema-like lesions to minimal variants of discrete erythema and digital purpura. Diagnosis depends on direct fluorescence studies of perilesional skin displaying granular IgA deposits in dermal papillae. Suspecting and then searching for dermatitis herpetiformis is often clinically challenging, as the disease is a true chameleon with many clinical faces. Dapsone therapy alleviates the cutaneous symptoms and signs, but does not prevent the systemic complications of celiac disease; thus, strict adherence to a gluten-free diet is strongly advisable.

Adolescent↗
PubMed2003

[From the New World. Louis A. Duhring and dermatitis herpetiformis].

Louis Adolphus Duhring (born December 23, 1845) died in Philadelphia, the city of his birth and life work, on May 8, 1913. After medical school, he studied for two years in dermatology departments in London, Paris and Vienna. As a student in Vienna, he was under the tutelage of Ferdinand von Hebra, when the brilliant clinician and teacher was at the zenith of his fame. Duhring's series of 18 papers--published between 1884 and 1891--gave him an important and recognized position as one of the leading dermatological thinkers of the world. These publications described the skin disease which he named "dermatitis herpetiformis" (Duhring's disease). His assertion that dermatitis herpetiformis was a distinct dermatological disease process aroused at first considerable opposition. Moriz Kaposi, at that time the doyen of the Vienna school of dermatology, attacked his views with vigor and tenacity. Louis A. Duhring--this modest, unassuming, quiet-working, gentlemanly physician--made monumental contributions to American dermatology and played a significant role in establishing Philadelphia as one of the great centers of dermatologic activity.

Dermatitis Herpetiformis↗
PubMed1978

The inhibition of polymorphonuclear leukocyte cytotoxicity by dapsone. A possible mechanism in the treatment of dermatitis herpetiformis.

The effect of the sulfone compound 4,4'-diaminodiphenyl sulfone (dapsone) on normal human polymorphonuclear leukocytes (PMNL) has been investigated in vitro. The drug has a dramatically beneficial effect in dermatitis herpetiformis in which the PMNL and immune complexes has been stressed to be of importance for the development of the skin lesions. Pruritus disappears and the inflammatory eruptions clear within a few days of starting therapy. The effect of dapsone has been evaluated on the different stages of phagocytosis. Using dapsone concentrations (1-30 mug/ml) comparable with those found after therapeutic doses, we have found that the drug interferes primarily with the myeloperoxidase (MPO)-H(2)O(2)-halide-mediated cytotoxic system in the PMNL. No effect was observed on random locomotion, chemotaxis, phagocytic ingestion, oxidative metabolism, or the release of lysosomal enzymes. Kinetic studies in a cell-free system with purified MPO revealed a competitive type of inhibition using varying concentrations of NaI. Furthermore, the inhibition resulted in reduced candidicidal activity during phagocytosis of Candida albicans, and reduced cytotoxicity to adjacent mammalian cells measured as the (51)Cr release from virus-induced lymphoma cells. Because the MPO-H(2)O(2)-halide system not only fulfills the antimicrobial activity but is suggested to be a modulator of the inflammatory reaction as well, the action of dapsone in dermatitis herpetiformis may in part be explained by its effect on this system.

Adolescent↗
PubMed1984

Immunohistochemical localization of epidermal basement membrane laminin and type IV collagen in bullous lesions of dermatitis herpetiformis.

Antibodies against the human basement membrane proteins, laminin and the 7-S domain of type IV collagen, were used to study the epidermal basement membrane in lesional skin from four patients with dermatitis herpetiformis. The staining pattern of both antigens was mostly fragmented and sometimes absent on papillary microabscesses, but when present it was attached to the epidermal basal cells. On papillary microblisters and larger blisters the staining of both antigens showed discontinuities and was located in the floor of the blister, except for two cases where tiny fragments of laminin staining were also seen in the roof of larger blisters. These results suggest that blister formation in dermatitis herpetiformis takes place between the epidermal basal cells and the basement membrane.

Adolescent↗
PubMed1992

Ultrastructural binding sites of endomysium antibodies from sera of patients with dermatitis herpetiformis and coeliac disease.

The ultrastructural binding sites of endomysium antibodies, specific serological markers of gluten sensitive enteropathy, were investigated in the rabbit oesophagus using the immunogold technique. Endomysium antibodies from sera of patients with dermatitis herpetiformis and with coeliac disease bound in an identical manner in a non-fibrillar material closely associated with fine collagenous-reticulin fibrils and also with similar fibrils connecting smooth muscle cells and elastic tissue in the endomysial connective tissue. These observations suggest that IgA antibodies in sera from patients with dermatitis herpetiformis and coeliac disease recognise a common antigen in an amorphous component associated with the reticular connective tissue of oesophageal lamina muscularis mucosae and thus confirm the probable identity of IgA class endomysium and jejunal antibodies.

Animals↗
PubMed1976

Pemphigus-like antibodies in dermatitis herpetiformis.

Pemphigus-like antibodies were demonstrated in a patient with dermatitis herpetiformis. The patient was a 28-year-old Japanese who showed itchy tense bullae on the back, chest and shoulders. We speculate the antibodies are similar to those found in burns, drug eruptions and certain other skin diseases.

Adult↗
PubMed1997

A subepidermal blistering disease with histopathological features of dermatitis herpetiformis and immunofluorescence characteristics of bullous pemphigoid: a novel subepidermal blistering disease or a variant of bullous pemphigoid?

A 64-year-old man presented with a bullous eruption which clinically and histopathologically resembled dermatitis herpetiformis. However, direct immunofluorescence analysis showed IgG deposits at the basement membrane zone, indicating a relationship with bullous pemphigoid or epidermolysis bullosa acquisita. Indirect immunofluorescence studies on salt-split skin showed binding of IgG mainly on the dermal side of the blister. Immunoblot analysis revealed a novel 200 kDa dermal antigen that could be associated with a major pathogen in this blistering disease. The histopathological similarity to dermatitis herpetiformis and the immunofluorescence findings indicating bullous pemphigoid or epidermolysis bullosa acquisita seem typical of a distinct subepidermal blistering disease characterized by this 200 kDa antigen. However, the pathogenetic role of autoantibodies against this antigen should be further elucidated before confirming whether this case represents a novel subepidermal blistering disease or a special variant of bullous pemphigoid.

Autoantigens↗
PubMed1984

Incidence and prevalence of dermatitis herpetiformis in western Sweden.

The annual incidence of IgA-positive dermatitis herpetiformis (DH) during the years 1976-1981 in Gothenburg, Sweden, a city with approximately 430000 inhabitants, was estimated prospectively. The mean annual incidence was 1.1 per 10(5) inhabitants. The prevalence of DH as at 31 December, 1981 was 22.9 per 10(5) inhabitants or 19.6 if patients in long-standing spontaneous remission were excluded. These figures probably represent the minimum overall prevalence rate.

Adult↗
PubMed1993

Dermatitis herpetiformis and established coeliac disease.

Fifteen (5.3%) of 282 patients with dermatitis herpetiformis (DH) were diagnosed as suffering from coeliac disease before the onset of their DH. This group showed a female preponderance, and a later than usual onset of DH. The mean age at which DH developed was 40.0 years, and there was a mean interval of 13.2 years between the two diagnoses. Seven patients had stopped their gluten-free diet, and a further four were poor compliers. Persistent gluten ingestion in coeliacs with a specific genetic predisposition may result in the development of DH.

Adolescent↗
PubMed1985

Influence of gluten-free diet on the gastric condition in dermatitis herpetiformis.

Achlorhydric atrophic gastritis occurs in approximately 25% of patients with dermatitis herpetiformis (DH). The effect of gluten withdrawal on the gastric condition was studied in 35 patients, with a control group of 20 patients continuing their habitual diet. Gastrointestinal examinations were performed initially and repeated after about 1 3/4 years. Adherence to the diet was confirmed by dietary interviews, improvement of malabsorption test results and intestinal villous structure, and decreased dapsone requirement. Neither the non-restricted diet nor the gluten-free diet had any effect on gastric morphology, the ability to secrete gastric acid, serum gastrin levels, or the frequency or titres of circulating parietal cell antibodies. The findings indicate that gluten is not responsible for the perpetuation of the gastric affection in DH, in contrast to the enteropathy.

Adolescent↗
PubMed1978

Dermatitis herpetiformis in Finland.

During a 3 1/2-year period, 492 patients with dermatitis herpetiformis (DH) visited the dermatological departments of Finnish hospitals. The prevalence of DH in Finland was 10.4 patients/100,000 inhabitants, or 1/10,000. About 60 patients contracted DH each year, giving an incidence of 1.3 patients/100,000 inhabitants/year. These figures show that DH is a rather common disease in Finland--much more so in Finland than in Britain. Its incidence does not differ much from that approximated for coeliac disease in Finland. DH occured in all parts of the country. The birth-places of the patients were distributed evenly over the whole country, in contrast to the distribution pattern of rare hereditary diseases in Finland. No significant difference was found in the occurrence of DH in areas with differing levels of wheat consumption or iodine intake.

Adolescent↗
PubMed1975

Dermatitis herpetiformis and small intestinal lesion--no strict association in german patients.

Dermatitis herpetiformis (DH) has been reported to be associated with various degrees of intestinal villous atrophy in 19 to 68 percent of the cases studied. This was true particularly in British and American populations. The present investigation deals with morphological and functional characteristics of small intestinal mucosa in a group of German DH patients (n=16): No case of villous atrophy could be detected, whereas interepithelial lymphocytes were shown to be slightly but significantly elevated. Intestinal disaccharidase activities were not statistically different from those of healthy control subjects, and oral lactose tolerance tests were normal in each of 8 patients tested. Genetical and immunological differences between our DH patients and those studied by British and American authors may be responsible for the basically different results as to "dermatogenic enteropathy".

Adult↗
PubMed1994

IgA antibodies against reticulin and endomysium in the serum and gastrointestinal secretions of patients with dermatitis herpetiformis.

Although IgA is present in the skin of patients with dermatitis herpetiformis (DH), the relationship of that IgA to the mucosal immune response is not known. The purpose of this study was to determine if IgA antibodies directed against tissue antigens, which are present in the serum of patients with DH, are also present in the gut secretions of these patients. Serum and gut secretions from 8 patients with DH and 5 control subjects were analyzed by indirect immunofluorescence for the presence of IgA antireticulin and antiendomysium antibodies. IgA antibodies against reticulin (3 of 8 patients) and endomysium (4 of 8 patients) were found in the serum of patients with DH. IgA antibodies were also present in the gut secretions of all of these patients, but not in subjects (patients with DH and controls) that did not have serum IgA antireticulin or antiendomysium antibodies. The presence of IgA antireticulin and antiendomysium in both the serum and gut secretions of DH patients suggests that these antibodies arise as a result of the mucosal immune response and that IgA of mucosal origin can persist in the serum of patients with DH.

Autoantibodies↗
PubMed1987

Dermatitis herpetiformis: extraction of intact IgA from granular deposits in dermal papillae.

Dermatitis herpetiformis (DH) is characterized by the granular deposition of IgA in the dermal papillary tips. The source and antigenic specificity of this IgA are unknown, largely because of the previous inability to isolate it for study. These granular IgA deposits, pathognomonic of DH, have been specifically isolated from 4-mm punch biopsies. Specific isolation was achieved by removing contaminating serum IgA by a combination of washes in saline and sodium dodecyl sulfate without a reducing agent present and mechanical isolation of papillary dermis. The tissue IgA was then solubilized by a buffer containing 1% sodium dodecyl sulfate and 0.2 mM dithiothreitol, a reducing agent. Immunoreactive alpha chains were recovered in eluates of DH skin in 6-fold greater amounts than in eluates of normal skin, coincident with disappearance of immunofluorescent-staining granular deposits of IgA. Extracted specific IgA was recovered in sufficient quantity for detection by immunoenzymatic stain, was partially composed of a native (165 Kd) molecular mass, and had alpha and kappa staining material, all indicating that the extracted immunoglobulin was in part intact.

Cytoplasmic Granules↗