Cutaneous Disorders Masking Celiac Disease: Case Report and Mini Review with Proposal for a Practical Clinical Approach

Abstract

Celiac disease (CD) is an immune-mediated systemic gluten-related disorder characterized by a wide spectrum of intestinal and extra-intestinal manifestations, including damage to cutaneous and connective tissue. We report a rare case of chronic severe dermatitis involving connective tissue and cutaneous vascular vessels as the main clinical presentation of undiagnosed seronegative gluten disorder. A gluten-free diet dramatically improved the intestinal and cutaneous clinical damage in the patient. Pitfalls and the steps of differential diagnosis are described. We also review the literature regarding studies of CD and connective tissue diseases to extend the knowledge of these rare associations. We propose a practical diagnostic approach in suspected CD in autoimmune cutaneous disorders.

Keywords: acrodermatitis entheropatica; celiac disease; connective tissue disease; dermatitis herpetiformis; gluten-free diet; skin; vasculitis.

Figure 1

Chronic dermatitis of the patient’s feet with dermographism and urticaria factitia, on the left (a) and on the right (b). Visible improvement of the patient’s lesions on her feet after GFD, with residual dyschromia and scarring (c).

Figure 2

Flow chart of the identified and selected studies.

Figure 3

CD Screening strategy and practical diagnostic approach in suspected CD in cutaneous autoimmune disorders. + = positive or present − = negative or not present.