Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram

Author:

Fernández-Bañares Fernando12ORCID,Crespo Laura3,Planella Montserrat4,Farrais Sergio5,Izquierdo Sandra6,López-Palacios Natalia7,Roy Garbiñe8ORCID,Vidal Judith9,Núñez Concepción1011ORCID

Affiliation:

1. Department of Gastroenterology, Hospital Universitari Mutua Terrassa, 08221 Terrasa, Spain

2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain

3. Department of Gastroenterology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain

4. Department of Gastroenterology, Hospital Arnau Vilanova, 25198 Lleida, Spain

5. Department of Gastroenterology, Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain

6. Department of Gastroenterology, Hospital Clínico Universitario, 47003 Valladolid, Spain

7. Department of Gastroenterology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, 28040 Madrid, Spain

8. Department of Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, 28034 Madrid, Spain

9. Section of Flow Cytometry, CATLAB, 08232 Viladecavalls, Spain

10. Laboratorio de Investigación en Genética de Enfermedades Complejas, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, 28040 Madrid, Spain

11. Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), 28029 Madrid, Spain

Abstract

Dermatitis herpetiformis is a cutaneous manifestation of celiac disease. Phenotyping of intraepithelial lymphocytes in the small bowel mucosa can strengthen the diagnosis of celiac disease when it is not clear-cut. We aim to evaluate the usefulness of the intraepithelial lymphogram to confirm dermatitis herpetiformis in equivocal cases. We performed a retrospective multicenter study on patients diagnosed with dermatitis herpetiformis and collected data from the intraepithelial lymphogram assessed by flow cytometry. A total of 36 patients were analyzed in relation to the severity of intestinal damage (18 had non-atrophic mucosa) at baseline (N = 28) and/or after the adoption of a gluten-free diet (median follow-up of three years, N = 16). We observed that patients with atrophy more often had positive celiac serology (p = 0.019), celiac clinical symptoms (p = 0.018), and iron-deficiency anemia (p = 0.018), but the severity of skin damage was similar in both groups (p = 0.79). At baseline, increased TCRγδ+ cells were present in 94% of patients with atrophy and 67% with non-atrophic lesions (p = 0.13). After a gluten-free diet, increased TCRγδ+ cells persisted in 100% and 63% of cases, respectively (p = 0.21). We concluded that increased TCRγδ+ cells may be helpful in confirming the diagnosis of dermatitis herpetiformis in equivocal cases, even in patients who were started on a gluten-free diet.

Funder

Instituto de Salud Carlos III

Publisher

MDPI AG

Subject

Food Science,Nutrition and Dietetics

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