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Dermatitis herpetiformis.

C Otley1, R P Hall

  • 1Department of Medicine, Duke University Medical Center, Durham, North Carolina.

Dermatologic Clinics
|October 1, 1990
PubMed
Summary
This summary is machine-generated.

Dermatitis herpetiformis (DH) pathogenesis involves specific HLA antigens, gluten-sensitive enteropathy (GSE), and IgA deposits in skin. A gluten-free diet resolves skin and gut issues, highlighting the gut

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Area of Science:

  • Immunodermatology
  • Gastroenterology
  • Genetics

Background:

  • Dermatitis herpetiformis (DH) is characterized by specific HLA antigens (HLA-B8, HLA-DR3, HLA-DQw2), associated gluten-sensitive enteropathy (GSE), and IgA deposits in skin.
  • The HLA class II antigens likely play a role in the immune system's initiating arm.
  • The HLA-A1, -B8, -DR3, -DQw2 haplotype is linked to various autoimmune diseases, suggesting a generalized immune susceptibility.

Purpose of the Study:

  • To elucidate the pathogenesis of Dermatitis herpetiformis (DH).
  • To understand the role of HLA antigens and gut abnormalities in DH.
  • To explore the origin of IgA deposits in DH skin.

Main Methods:

  • Analysis of key characteristics: HLA antigen frequency, GSE association, response to gluten-free diet, and IgA skin deposits.

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  • Review of existing literature on HLA associations and pathogenetic theories.
  • Consideration of in vitro lymphocyte responses and Fc-IgG receptor functions in individuals with specific HLA haplotypes.

    • Main Results:

    • DH pathogenesis is linked to specific HLA antigens, GSE, and IgA deposition in the skin.
    • A gluten-free diet effectively treats both skin lesions and gut abnormalities in DH patients.
    • The gut disease is a critical factor in DH pathogenesis.
    • Proposed theories for IgA deposits include gut-derived IgA cross-reacting with skin, IgA binding to gut antigens and depositing in skin, or gut permeability allowing antigen access.

    Conclusions:

    • The pathogenesis of DH is multifactorial, involving genetic predisposition (HLA), gut pathology (GSE), and immune responses leading to IgA deposition in the skin.
    • The gut plays a central role, with a gluten-free diet being curative.
    • The exact mechanism of IgA deposition requires further investigation, with possibilities including antigen-antibody reactions or non-specific binding.