Gluten-related skin disorders: clinical presentation, diagnostic and treatments

Abstract

Gluten-related disorders (GRDs) encompass a spectrum of clinical manifestations triggered by gluten ingestion in genetically susceptible individuals. These disorders include celiac disease (CD) and non-celiac gluten sensitivity (NCGS) and present with both intestinal and extraintestinal symptoms, including skin manifestations. Besides the well-known association between CD and dermatitis herpetiformis, considered as the cutaneous manifestation of CD, other dermatoses have been associated to GRDs. In this paper, we provide a concise overview of the clinical appearance, diagnosis and therapeutic management of GRDs, a tool which we hope will facilitate clinicians when faced with this challenging group of diseases.

Keywords: Coeliac disease; dermatitis herpetiformis; gluten sensitive enteropathy; gluten‐free diet; transglutaminase.

FIGURE 1

Clinical features of dermatitis herpetiformis. (a) Grouped erythematous papules arranged in an herpetiform pattern. (b) Skin excoriation due to intense pruritus, typical for dermatitis herpetiformis. (c) Small blisters on erythematous skin in a patient with phototype V according to Fitzpatrick's phototype classification. (d) Excoriations on the forehead.

FIGURE 2

Histological and immunopathological features of dermatitis herpetiformis. (a) Detection of granular IgA deposits along the dermo‐epidermal junction by direct immunofluorescence. (b, c) Subepidermal detachment with neutrophilic microabscess (hematoxylin‐eosin stain [HE], original magnification x 4). (d) Detail of a neutrophilic microabscess (HE, x 20).