Dermatitis herpetiformis, celiac disease and their impact on women and their families

Abstract

Dermatitis herpetiformis (DH) is the specific cutaneous manifestation of celiac disease (CD), both of which require lifelong management. A comprehensive literature review was conducted to gather evidence on gender-related differences aiming at reducing healthcare inequalities. While women tend to be more symptomatic, the diagnosis is often delayed, leading to a reduced quality of life and an increased risk of long-term complications. This may be partly a consequence of the fact that they are more likely to present with seronegative forms. Moreover, in women, reproductive issues, known to be associated with DH and CD, along with osteopenia/osteoporosis, and anemia are particularly prevalent. It should be also noted that beyond personal diagnosis, DH and CD also affect women indirectly, as they often take on caregiving roles for affected family members. The lifelong adherence to a gluten-free diet, the only effective treatment for DH, imposes a substantial lifestyle and financial burden. Gluten-free diet is frequently perceived as both gendered and class-based, placing a disproportionate strain on women and lower-income households. In this regard, recent recommendations to prioritize naturally gluten-free foods rather than "gluten-free" products, may offer some relief. However, the responsibility for acquiring the skills necessary for such dietary choices often falls predominantly on women.