Skin Manifestations and Coeliac Disease in Paediatric Population

Abstract

Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.

Keywords: children; coeliac disease; skin manifestation.

Figure 1

Dermatitis Herpetiformis. (A) Erythematous, papular, and vesiculosus lesions in a 14 year old child with Atopic Dermatitis and diagnosis of Celiac disease. (B,C) a magnification of the DH shows a typical polymorphism consisting of erythema, urticarial plaques, papules, grouped vesicles and blisters associated with intense itch and therefore followed by erosions, excoriations, and hyperpigmentation.

Figure 2

Alopecia Areata. (A) nonscarring hair loss in a 16 year old woman with onset diagnosis of Celiac Disease. (B) Dermoscopic image with a magnification 20×: dermoscopic features in alopecia areata are black dots (cadaverous hairs), yellow dots, tapering hairs (exclamation mark hairs), and broken hairs.

Figure 3

Atopic Dermatitis. (A,B) erythema, lichenification, scaling, and prurigo in a 6 years old child. Excoriated bilateral erythematous scaling papules and plaques on the surface of the lower limbs.