diagnosis. Biopsy needs to be performed on perilesional skin (clinically normal-appearing skin immediately adjacent to an area of inflammation). False negatives may occur if a biopsy is performed on involved skin.  All patients with DH have some degree of coeliac disease, and are very likely to reflect the entire spectrum of histologic and clinical coeliac disease in adults. No consistent serologic or immunologic difference between patients with DH and patients with coeliac disease has ever been identified.  Clinically, 10-20% of patients with DH present with classic symptoms of malabsorption and another 20% are estimated to have atypical symptoms, but at least 60% of patients have 'silent' coeliac disease.  The presence of DH is a marker of coeliac disease that is independent of the severity of histologic coeliac disease or the intestinal symptoms.

Management

The condition is managed by a gluten-free diet and drug treatment. A gluten-free diet, can often take several months before the rash improves and nearly 2 years before it disappears completely. Both the skin disease and the intestinal disease recur with reinstitution of a diet containing gluten.  Drugs, such as Dapsone (Diaminodiphenylsulfone), are an important part of the management of DH. The cutaneuos disease in DH clears rapidly on treatment with Dapsone, and recurs rapidly if Dapsone is discontinued. Dapsone has no influence on intestinal abnormality. Side-effects of Dapsone include haemolytic anaemic, neuropathy, depression, and headache.

Long term consequences

Many of the long-term implications of coeliac disease are also relevant to patients with DH, including lymphoma. The clinical associations include thyroid abnormalities, which occur in 15-20% of patients. Courtes of Coeliac UK
(published with permission in writing from:http://www.coeliac.co.uk/)




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