Prognosis

Disease course

Dermatitis herpetiformis, if not treated, runs a chronic relapsing course with exacerbations followed by phases in which signs and symptoms are less severe.[1] After a gluten-free diet is adopted, most patients slowly improve until they achieve complete remission. However, cutaneous manifestations may last for months to years after starting a gluten-free diet.[61] In these patients, treatment with dapsone is often able to induce remission in just a few days, although the treatment should be prolonged until all skin lesions have resolved as early discontinuation may cause relapse.[62]

Re-introduction of gluten

Dermatitis herpetiformis is nearly always associated with coeliac disease and a lifelong gluten-free diet should be maintained.[63] Almost all patients with long-lasting remission will experience a relapse if they re-introduce gluten into their diet. In one study, 10 out of 86 patients with dermatitis herpetiformis did not show relapses of cutaneous manifestations, although their intestinal status was not assessed.[49] More recently, 20 patients with dermatitis herpetiformis re-introduced gluten into their diet after complete remission of the disease. At 1 year, all but one showed skin or intestinal relapse.[62]

Mortality

The life expectancy of people with dermatitis herpetiformis appears to be increased compared with that of the general population and that of people with coeliac disease.[64][65] The increased life expectancy rates compared with the general population may be explained by a number of reasons, including strict adherence to a gluten-free diet, and lower levels of smoking and hypercholesterolaemia in people with dermatitis herpetiformis.[64] Complications that may occur in patients with coeliac disease and may lead to death, such as lymphoma, although reported, are very rare in patients with dermatitis herpetiformis and the risk may be minimised by following a gluten-free diet.[66]

Use of this content is subject to our disclaimer