Dermatitis Herpetiformis

Dermatitis herpetiformis is an uncommon, intensely pruritic mucocutaneous disorder related to coeliac disease that only occasionally involves the mouth [126]. Oral lesions present as areas of erythema and clusters of small, friable vesicles or superficial, painful ulcers. The lesions can involve both keratinised and non-ke-ratinised mucosa and head and neck cutaneous lesions tend to affect the scalp and periorbital regions. Dermatitis herpetiformis is seen most frequently in teenagers and young adults, particularly males, and there is a predilection in people of Anglo-Saxon and Scandinavian origin. There is a strong association between dermatitis herpetiformis and gluten-sensitive enteropathy. The Class I antigen HLA-B8 is found in the large majority of patients with both dermatitis herpetiformis and co-eliac disease, and HLA-DR3 is expressed in nearly 95% of patients.

Clinically, oral dermatitis herpetiformis presents as patches of mucosal erythema, clusters of small vesicles, herpetiform ulcers or more extensive areas of non-heal-

Linear IgA disease is a rather poorly defined heterogeneous group of mucocutaneous blistering disorders that closely resemble mucous membrane pemphigoid clinically and microscopically [160, 191]. Like pemphigoid, the eyes may be involved. Linear IgA disease in adults has been separated from similar conditions in childhood such as bullous dermatosis of childhood and childhood cicatricial pemphigoid. Cutaneous linear IgA disease of adults has a strong association with a history of bowel disease. This association is much less clear in patients with oral lesions. However, patients with oral linear IgA disease appear to have a higher risk of severe ocular lesions. Some cases of oral lesions have been associated with drugs [51]. The condition is more common in women than men and it usually presents as a desquamative gingivitis with, or without, ulceration.

Microscopy shows subepithelial vesiculation and full thickness blister formation. Direct immunofluo-rescence shows linear deposition of IgA along the BMZ and a low titre of circulating IgA to the BMZ. Although small amounts of IgG, IgM and C3 may be seen, if these are present in other than trace amounts mucous membrane pemphigoid is a much more likely diagnosis.

Linear IgA disease tends to be refractory to systemic steroids, but it may respond to dapsone or sulphono-mides.

Why Gluten Free

Why Gluten Free

What Is The Gluten Free Diet And What You Need To Know Before You Try It. You may have heard the term gluten free, and you may even have a general idea as to what it means to eat a gluten free diet. Most people believe this type of diet is a curse for those who simply cannot tolerate the protein known as gluten, as they will never be able to eat any food that contains wheat, rye, barley, malts, or triticale.

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