Dermatitis herpetiformis: Novel advances and hypotheses

Dermatitis herpetiformis(DH)is a gluten-sensitive autoimmune blistering disorder with a chronic-relapsing course.Very recently,several Authors reported atypical cases of patients with DH,suggesting that different clinical subsets may exist at least among different ethnicities and that the classical picture of DH probably need a significant revision.Moreover,different pathogenetic aspects of the disease are currently under investigation,including the role of epidermal transglutaminase,apoptosis and inflammatory cells in the occurrence of skin lesions,in order to explain why only a subgroup of celiac patients will develop DH.Finally,although glutenfree diet is still regarded as the only curative approach to the disease,it is very hard to comply with and even small amounts of gluten can re-activate the disease.Therefore,different therapeutical approaches for the spectrum DH/celiac disease are still under investigation.In the present paper,the most recent advances in DH will be discussed,and a novel interpretation of the disease based on the data emerging from the Literature will be proposed.

Association between celiac disease and vitiligo:A review of the literature

Celiac disease(CD)is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes.Vitiligo is a commonly acquired depigmentation of the skin;its clinical manifestation are skin patches caused by localized or generalized melanin deficiency.Both diseases have similar global incidence rates(approximately 1%)and are associated to similar diseases,including autoimmune bullous disease,inflammatory bowel disease,autoimmune thyroiditis,autoimmune gastritis,and type 1 diabetes.The relationship between CD and vitiligo has been reported in several studies,but their conclusions are inconsistent.Further,it has also been reported that a gluten-free diet(GFD)can improve the symptoms of immunerelated skin diseases such as vitiligo.In this mini-review,we summarize and review the literature on the relationship between CD and vitiligo,assess the therapeutic significance of GFD for patients with vitiligo,and explore their possible physiopathology.We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo,thereby improving the prognosis.