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Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram
Fernando Fernández-Bañares1,2, Laura Crespo3, Montserrat Planella4
1Department of Gastroenterology, Hospital Universitari Mutua Terrassa, 08221 Terrasa, Spain.
Insights
Increased TCRγδ+ cells in the small bowel may help diagnose dermatitis herpetiformis (DH), a skin condition linked to celiac disease. This finding is useful even for patients on a gluten-free diet, aiding diagnosis in unclear cases.
Area of Science:
- Gastroenterology
- Dermatology
- Immunology
Background:
- Dermatitis herpetiformis (DH) is a skin manifestation of celiac disease.
- Diagnosing DH can be challenging, especially in equivocal cases.
- Intraepithelial lymphocyte phenotyping in small bowel mucosa aids celiac disease diagnosis.
Purpose of the Study:
- To assess the utility of intraepithelial lymphogram, specifically TCRγδ+ cell counts, in confirming DH.
- To evaluate this diagnostic marker in patients with varying degrees of intestinal damage and on a gluten-free diet.
Main Methods:
- Retrospective multicenter study of 36 patients diagnosed with DH.
- Intraepithelial lymphogram analysis using flow cytometry.
- Correlation of TCRγδ+ cell counts with intestinal damage severity and celiac serology.
Main Results:
- Patients with intestinal atrophy showed higher rates of positive celiac serology, symptoms, and anemia.
- Increased TCRγδ+ cells were observed in 94% of patients with atrophy and 67% without at baseline.
- Elevated TCRγδ+ cells persisted after a gluten-free diet in 100% of atrophic and 63% of non-atrophic cases.
Conclusions:
- Elevated TCRγδ+ cells are a potential biomarker for confirming DH in ambiguous cases.
- This finding holds relevance even for patients adhering to a gluten-free diet.
- Intraepithelial lymphogram analysis can strengthen DH diagnosis when clinical or serological data are inconclusive.
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.
