Cutaneous and Mucosal Manifestations Associated with Celiac Disease

Abstract

Celiac disease (CD) is an immune-mediated, gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, with dermatitis herpetiformis (DH) being the best characterized. These associated conditions may be the clue to reaching the diagnosis of CD. Over the last few years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in the absence of gastrointestinal symptoms, should give rise to an appropriate screening method for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated with CD and the possible mechanisms involved.

Keywords: alopecia areata; atopic dermatitis; celiac disease; cutaneous vasculitis; dermatitis herpetiformis; gluten-free diet; psoriasis; recurrent aphtous ulceration; rosacea; urticaria.

Figure 1

Urticaria. Pale to red, well-demarcated, transient swellings, involving the dermis, mainly at the thorax and the left arm.

Figure 2

Atopic dermatitis. Excoriated bilateral erythematous scaling papules and plaques on the right flexor elbow surface.

Figure 3

Extense plaque of psoriasis at the left elbow extensor side.

Figure 4

Psoriasis. Well demarcated, erythematous, scaly plaques that are relatively symmetrical on the back.

Figure 5

Aphthous lesion on the tip of the tongue, on the upper side.

Figure 6

Rosacea. Papule-pustular lesions on the face.

Figure 7

Alopecia areata. Patchy head hair loss.

Figure 8

Vasculitis. Palpable purpuric papules on the lower extremities.