Gluten-Free Diet and Reintroduction of Gluten in Dermatitis Herpetiformis

Abstract

Seven patients with dermatitis herpetiformis were given a gluten-free diet, six for one year and one for six months. Skin lesions cleared in three patients, who no longer required dapsone, and reappeared with normal diet. In three others dapsone requirements fell with a gluten-free diet but increased again in two with normal diet. There was improvement in the macroscopic appearance of the small intestine, height of the intestinal villi, surface epithelial cell height, fecal fat excretion, and serum and red cell folate with the gluten-free diet, and reversal on reintroduction of gluten. These findings demonstrate that the enteropathy in dermatitis herpetiformis is due to gluten sensitivity. There was a correlation between the improvement in the small intestine and the skin disorder, suggesting a direct relationship between the two organs in this disease.