The small intestine in dermatitis herpetiformis

Area of Science:

• Gastroenterology
• Immunology
• Dermatology

Background:

• Dermatitis herpetiformis is an autoimmune blistering skin condition.
• It is strongly associated with celiac disease, a form of gluten-sensitive enteropathy.
• Diagnosis often involves skin and small intestinal biopsies.

Purpose of the Study:

• To investigate the intraepithelial lymphocyte counts in small intestinal biopsies of patients with dermatitis herpetiformis.
• To differentiate the distribution of lymphocytes in normal versus affected individuals.
• To correlate biopsy findings with the diagnosis of gluten-sensitive enteropathy.

Main Methods:

• Studied 43 small intestinal biopsies from dermatitis herpetiformis patients and 20 controls.
• Assessed macroscopic appearance of biopsies (flat, convoluted, leaves only, fingers and leaves).
• Quantified intraepithelial lymphocyte counts at basal, perinuclear, and supranuclear positions.

Main Results:

• Dermatitis herpetiformis patients had significantly higher total intraepithelial lymphocyte counts than controls (P < 0.001).
• Lymphocyte increase was predominantly in the perinuclear and supranuclear regions in affected patients.
• The ratio of basal to peri/supranuclear lymphocytes shifted from 1:1 (normal) to approximately 1:4 in dermatitis herpetiformis.

Conclusions:

• Increased intraepithelial lymphocytes, especially in perinuclear and supranuclear areas, are characteristic of gluten-sensitive enteropathy in dermatitis herpetiformis.
• Small intestinal biopsy analysis of lymphocyte distribution is a valuable diagnostic tool.
• Findings support the link between dermatitis herpetiformis and gluten-induced enteropathy.