Theoretical-practical approach to herpetiform dermatitis as the main cutaneous manifestation of celiac disease: An integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v10i6.15276

Keywords:

Herpertiformis dermatites; Celiac disease; Skin lesions; Versiculobullous lesions.

Abstract

Introduction: Dermatitis herpetiformis (DH) is a benign, chronic, inflammatory manifestation of the skin. The lesions are erythemato-papular vesicular eruptions, pruritic, symmetrical, herpetiform in shape, and have an affinity for extensor surfaces. It is male-dominant, between the ages of 30 and 40, and is related to abnormalities of the small intestinal mucosa and to IgA deposition in the papillary dermis. It has a multifactorial origin, encompassing genetic, environmental, and immunologic components. Objectives: To analyze the application of knowledge obtained by integrative review addressing dermatitis herpetiformis and celiac disease (CD) to develop a clinical rationale for early diagnosis and effective treatment. Methodology: Scientific and review articles published and referenced in MEDLINE, LILACS, IBECS, BINACIS, LIS, BRISA/RedTESA and MEdCArib were consulted, delimited from 2008 to 2019. The books "Tratado de dermatologia" by Belda Júnior and "Dermatologia" by Sampaio and Rivitti were also included. Results: The diagnosis of DH is clinical, laboratory and immunological. The presentation and eruption activity of the blisters is variable. The classic histopathologic finding is a subepidermal cleft with neutrophils and eosinophils in the dermal papillae, with perivesicular mixed inflammatory infiltrate. Direct immunofluorescence of uninvolved skin is the gold standard. The mainstay of treatment involves a gluten-free diet coupled with the use of medications.Incomplete remission is frequently observed in patients who do not restrict gluten. Conclusion: Knowledge of the clinical and subclinical manifestations of DH and CD as well as laboratory findings is crucial for early diagnosis, helping to rule out misdiagnosis, exacerbations, or complications.

Author Biography

Evandra Marielly Leite Nogueira Freitas Galvão , Centro Universitário UNINOVAFAPI

Graduated in MEDICINE from Faculdade Integral Diferencial (2010). Specialist in Dermatology by the Brazilian Society of Dermatology and the Brazilian Medical Association. Professor of the Discipline of Dermatology at the State University of Piauí and Centro Universitário Uninovafapi. Physician at the Municipal Health Foundation of Teresina. Operates in the field of Hansenology.

 

References

Barbosa, W. S., Rodarte, C. M., Guerra, J. G., Maciel, V. G., Fleury Júnior, L. F., & Costa, M. B. (2011). Lúpus eritematoso sistêmico bolhoso: diagnóstico diferencial com dermatite herpetiformeBullous systemic lupus erythematosus: differential diagnosis with dermatitis herpetiformis. Anais Brasileiros de Dermatologia, 86(4, Suppl. 1), 92-95. https://dx.doi.org/10.1590/S0365-05962011000700024

Belda Junior, W., Di Chiacchio, N., Criado, P. R. (2015). Tratado de dermatologia (2nd ed.) Editora Atheneu. ISBN 853880538X.

Bonciolini, V., Antiga, E., Bianchi, B., Del Bianco, E., Ninci, A., Maio, V., Pimpinelli, N., & Caproni, M. (2019). Granular IgA Deposits in the Skin of Patients with Coeliac Disease: Is it Always Dermatitis Herpetiformis?. Acta dermato-venereologica, 99(1), 78–83. https://doi.org/10.2340/00015555-3001

Calado, G., Loureiro, G., Ribeiro, C., Machado, D., Tavares, B., & Chieira, C. (2008). Dermatite herpetiforme como manifestação inicial de doenças celíaca durante a gravidez: caso clínico. Revista Portuguesa de Imunoalergologia, 16(6), 573-582. http://hdl.handle.net/10400.4/1262

Castro, C. G. C., Cunha, C. G., de Lima, C. M., dos Reis, D. Z., Sirio, D. M. B., Bernardes Filho, F., & Plata, G. T. (2014). Dermatite herpetiforme com exacerbação clínica após interrupção do uso de anovulatório oral. Journal of the Portuguese Society of Dermatology and Venereology, 72(2), 219-222. https://doi.org/10.29021/spdv.72.2.258

Clarindo, M. V., Possebon, A. T., Soligo, E. M., Uyeda, H., Ruaro, R. T., & Empinotti, J. C. (2014). Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment. Anais brasileiros de dermatologia, 89(6), 865–877. https://doi.org/10.1590/abd1806-4841.20142966

Costin, A., António, A. M., Furtado, C., & Bártolo, E. (2019). Dermatitis herpetiformis in an adolescent patient. Anais brasileiros de dermatologia, 94(4), 495–496. https://doi.org/10.1590/abd1806-4841.20198227

Coutinho, I., Jerónimo, M., Brinca, A., Tellechea, Ó., Moreno, A., & Figueiredo, A. (2014). Dermatite herpetiforme em idade pediátrica–um diagnóstico a ter em conta. Journal of the Portuguese Society of Dermatology and Venereology, 72(3), 371-375. https://doi.org/10.29021/spdv.72.3.281

Doffoel-Hantz, V., Cogne, M., Sparsa, A., Bonnetblanc, J. M., Drouet, M., Bedane, C. (2008). Physiopathologie de la dermatite herpétiforme. In: Annales de dermatologie et de vénéréologie. Elsevier Masson, 135(11), 789-790. https://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20810482

Farinha, S., Jordão, F., Tomaz, E., & Inácio, F. (2018). Dermatite herpetiforme. Caso clínico. Revista Portuguesa de Imunoalergologia, 26(2), 127-131. https://www.researchgate.net/profile/Sofia-Farinha-2/publication/326941464_Dermatitis_herpetiformis_Clinical_case/links/5d91df0a299bf10cff1a56f0/Dermatitis-herpetiformis-Clinical-case.pdf

Hervonen, K., Salmi, T. T., Ilus, T., Paasikivi, K., Vornanen, M., Laurila, K., Lindfors, K., Viiri, K., Saavalainen, P., Collin, P., Kaukinen, K., & Reunala, T. (2016). Dermatitis Herpetiformis Refractory to Gluten-free Dietary Treatment. Acta dermato-venereologica, 96(1), 82–86. https://doi.org/10.2340/00015555-2184.

Kotze, L. M. (2013). Dermatitis herpetiformis, the celiac disease of the skin!. Arquivos de gastroenterologia, 50(3), 231–235. https://doi.org/10.1590/S0004-28032013000200041

Mendes, F. B., Hissa-Elian, A., Abreu, M. A., & Gonçalves, V. S. (2013). Review: dermatitis herpetiformis. Anais brasileiros de dermatologia, 88(4), 594–599. https://doi.org/10.1590/abd1806-4841.20131775

Obermoser, G., & Pascual, V. (2010). The interferon-α signature of systemic lupus erythematosus. Lupus, 19(9), 1012–1019. https://doi.org/10.1177/0961203310371161

Reunala, T., Salmi, T. T., & Hervonen, K. (2015). Dermatitis herpetiformis: pathognomonic transglutaminase IgA deposits in the skin and excellent prognosis on a gluten-free diet. Acta dermato-venereologica, 95(8), 917–922. https://doi.org/10.2340/00015555-2162

Reunala, T., Salmi, T. T., Hervonen, K., Kaukinen, K., & Collin, P. (2018). Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease. Nutrients, 10(5), 602. https://doi.org/10.3390/nu10050602

Rivitti, E. A. (2018). Dermatologia de Sampaio e Rivitti (4nd ed.). Artes medicas.

Salmi T. T. (2019). Dermatitis herpetiformis. Clinical and experimental dermatology, 44(7), 728–731. https://doi.org/10.1111/ced.13992

Sgnaolin, V., Baldisserotto, V., Stein, RT, & Epifanio, M. (2014). Dermatite herpetiforme como manifestação única da doença celíaca: relato de caso e revisão da literatura. Scientia Medica , 23 (4), 250-254. https://doi.org/10.15448/1980-6108.2013.4.15468

Souza, M. T. D., Silva, M. D. D., & Carvalho, R. D. (2010). Revisão integrativa: o que é e como fazer. Einstein (São Paulo), 8(1), 102-106. http://dx.doi.org/10.1590/s1679-45082010rw1134

Tincopa, M., Puttgen, K. B., Sule, S., Cohen, B. A., & Gerstenblith, M. R. (2010). Bullous lupus: an unusual initial presentation of systemic lupus erythematosus in an adolescent girl. Pediatric dermatology, 27(4), 373–376. https://doi.org/10.1111/j.1525-1470.2010.01179.x

Vale, E., Dimatos, O. C., Porro, A. M., & Santi, C. G. (2019). Consensus on the treatment of autoimmune bullous dermatoses: dermatitis herpetiformis and linear IgA bullous dermatosis - Brazilian Society of Dermatology. Anais brasileiros de dermatologia, 94(2 Suppl 1), 48–55. https://doi.org/10.1590/abd1806-4841.2019940208

Published

27/05/2021

How to Cite

HOLANDA, S. M. M. S. C. de .; NUNES , R. M. de O.; SILVA , L. A. dos S.; BARROS , M. M. de; SILVA , P. H. F.; ASSUNÇÃO , A. J. T.; MOURA , A. C.; GALVÃO , E. M. L. N. F. Theoretical-practical approach to herpetiform dermatitis as the main cutaneous manifestation of celiac disease: An integrative review. Research, Society and Development, [S. l.], v. 10, n. 6, p. e18110615276, 2021. DOI: 10.33448/rsd-v10i6.15276. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/15276. Acesso em: 23 jun. 2021.

Issue

Section

Review Article