Sex-differences in Gluten-free Dietary Adherence and Clinical Symptoms in Patients with Long-term Treated Dermatitis Herpetiformis
DOI:
https://doi.org/10.2340/actadv.v102.1072Keywords:
dermatitis herpetiformis, gluten-free diet, gastrointestinal symptoms, quality of life, sex differencesAbstract
Dermatitis herpetiformis is a blistering autoimmune skin disease, and a cutaneous manifestation of coeliac disease. The burden of coeliac disease is increased especially in females, but studies concerning sex differences in patients with long-term treated dermatitis herpetiformis are scarce. This questionnaire study compared adherence to a gluten-free diet, clinical symptoms and well-being between females and males in a cohort of 237 long-term treated (median 24 years) patients with dermatitis herpetiformis. Females had better adherence to a gluten-free diet (p = 0.022) and they used dapsone significantly less often at the time of the study than did males (4% vs 13%, p = 0.017). The occurrence of skin symptoms was equal in both sexes, but dermatological quality of life was lower in females (p = 0.024), and gastrointestinal symptoms were more severe among females with dermatitis herpetiformis than among males (p = 0.027). In conclusion, long-term treated female patients with dermatitis herpetiformis have better adherence to a gluten-free diet, but they also experience more severe clinical symptoms compared with males.
Downloads
References
Salmi T, Hervonen K. Current concepts of dermatitis herpetiformis. Acta Derm Venereol 2020; 100: 115-121.
https://doi.org/10.2340/00015555-3401 DOI: https://doi.org/10.2340/00015555-3401
Savilahti E, Reunala T, Maki M. Increase of lymphocytes bearing the γ/δ T cell receptor in the jejunum of patients with dermatitis herpetiformis. Gut 1992; 33: 206-211.
https://doi.org/10.1136/gut.33.2.206 DOI: https://doi.org/10.1136/gut.33.2.206
Alakoski A, Salmi TT, Hervonen K, Kautiainen H, Salo M, Kaukinen K, et al. Chronic gastritis in dermatitis herpetiformis: a controlled study. Clin Dev Immunol 2012; 2012: 640630.
https://doi.org/10.1155/2012/640630 DOI: https://doi.org/10.1155/2012/640630
Salmi TT, Hervonen K, Kautiainen H, Collin P, Reunala T. Prevalence and incidence of dermatitis herpetiformis: a 40-year prospective study from Finland. Br J Dermatol 2011; 165: 354-359.
https://doi.org/10.1111/j.1365-2133.2011.10385.x DOI: https://doi.org/10.1111/j.1365-2133.2011.10385.x
West J, Fleming KM, Tata LJ, Card TR, Crooks CJ. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study. Am J Gastroenterol 2014; 109: 757-768.
https://doi.org/10.1038/ajg.2014.55 DOI: https://doi.org/10.1038/ajg.2014.55
Lindfors K, Ciacci C, Kurppa K, Lundin KEA, Makharia GK, Mearin ML, et al. Celiac disease. Nat Rev Dis Prim 2019; 5: 3.
https://doi.org/10.1038/s41572-018-0054-z DOI: https://doi.org/10.1038/s41572-018-0054-z
Hervonen K, Vornanen M, Kautiainen H, Collin P, Reunala T. Lymphoma in patients with dermatitis herpetiformis and their first-degree relatives. Br J Dermatol 2005; 152: 82-86.
https://doi.org/10.1111/j.1365-2133.2005.06345.x DOI: https://doi.org/10.1111/j.1365-2133.2005.06345.x
Pasternack C, Hervonen K, Mansikka E, Reunala T, Collin P, Kaukinen K, et al. Persistent skin symptoms after diagnosis and on a long-term gluten-free diet in dermatitis herpetiformis. Acta Derm Venereol 2021; 101: adv00555.
https://doi.org/10.2340/00015555-3914 DOI: https://doi.org/10.2340/00015555-3914
See JA, Kaukinen K, Makharia GK, Gibson PR, Murray JA. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol 2015; 12: 580-591.
https://doi.org/10.1038/nrgastro.2015.156 DOI: https://doi.org/10.1038/nrgastro.2015.156
Zarkadas M, Dubois S, Macisaac K, Cantin I, Rashid M, Roberts KC, et al. Living with coeliac disease and a gluten-free diet: a Canadian perspective. J Hum Nutr Diet 2013; 26: 10-23.
https://doi.org/10.1111/j.1365-277X.2012.01288.x DOI: https://doi.org/10.1111/j.1365-277X.2012.01288.x
Roos S, Kärner A, Hallert C. Psychological well-being of adult coeliac patients treated for 10 years. Dig Liver Dis 2006; 38: 177-182.
https://doi.org/10.1016/j.dld.2006.01.004 DOI: https://doi.org/10.1016/j.dld.2006.01.004
Hallert C, Grännö C, Hulten S, Midhagen G, Ström M, Svensson H, et al. Living with coeliac disease. Scand J Gastroenterol 2002; 37: 39-42
https://doi.org/10.1080/003655202753387338 DOI: https://doi.org/10.1080/003655202753387338
Hallert C, Grännö C, Grant C, Hulten S, Midhagen G, Ström M, et al. Quality of life of adult coeliac patients treated for 10 years. Scand J Gastroenterol 1998; 33: 933-938.
https://doi.org/10.1080/003655298750026949 DOI: https://doi.org/10.1080/003655298750026949
Paavola A, Kurppa K, Ukkola A, Collin P, Lahdeaho ML, Huhtala H, et al. Gastrointestinal symptoms and quality of life in screen-detected celiac disease. Dig Liver Dis 2012; 44: 814-818.
https://doi.org/10.1016/j.dld.2012.04.019 DOI: https://doi.org/10.1016/j.dld.2012.04.019
Midhagen G, Hallert C. High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study. Am J Gastroenterol 2003; 98: 2023-2026.
https://doi.org/10.1111/j.1572-0241.2003.07632.x DOI: https://doi.org/10.1111/j.1572-0241.2003.07632.x
Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther 2009; 30: 315-330.
https://doi.org/10.1111/j.1365-2036.2009.04053.x DOI: https://doi.org/10.1111/j.1365-2036.2009.04053.x
Leffler DA, Edwards-George J, Dennis M, Schuppan D, Cook F, Franko DL, et al. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig Dis Sci 2013; 53: 1573-1581.
https://doi.org/10.1007/s10620-007-0055-3 DOI: https://doi.org/10.1007/s10620-007-0055-3
Kurppa K, Lauronen O, Collin P, Ukkola A, Laurila K, Huhtala H, et al. Factors associated with dietary adherence in celiac disease: a nationwide study. Digestion 2013; 86: 309-314.
https://doi.org/10.1159/000341416 DOI: https://doi.org/10.1159/000341416
Schiepatti A, Maimaris S, Nicolardi ML, Alimenti E, Vernero M, Costetti M, et al. Determinants and trends of adherence to a gluten-free diet in adult celiac patients on a long-term follow-up (2000-2020). Clin Gastroenterol Hepatol 2022; 20: e741-e749.
https://doi.org/10.1016/j.cgh.2020.12.015 DOI: https://doi.org/10.1016/j.cgh.2020.12.015
Pasternack C, Kaukinen K, Kurppa K, Mäki M, Collin P, Reunala T, et al. Quality of life and gastrointestinal symptoms in long-term treated dermatitis herpetiformis patients: a cross-sectional study in Finland. Am J Clin Dermatol 2015; 16: 545-552.
https://doi.org/10.1007/s40257-015-0149-1 DOI: https://doi.org/10.1007/s40257-015-0149-1
Mansikka E, Salmi T, Kaukinen K, Collin P, Huhtala H, Reunala T, et al. Diagnostic delay in dermatitis herpetiformis in a high-prevalence area. Acta Derm Venereol 2018; 7: 195-199.
https://doi.org/10.2340/00015555-2818 DOI: https://doi.org/10.2340/00015555-2818
Zone JJ, Meyer LJ, Petersen MJ. Deposition of granular IgA relative to clinical lesions in dermatitis herpetiformis. Arch Dermatol 1996; 132: 912-918. DOI: https://doi.org/10.1001/archderm.132.8.912
https://doi.org/10.1001/archderm.1996.03890320060010 DOI: https://doi.org/10.1001/archderm.1996.03890320060010
Coeliac Disease. Current Care Guidelines. Working group set up by the Finnish Medical Society Duodecim and the Finnish Gastroenterology Society. Helsinki: The Finnish Medical Society Duodecim, 2018 [accessed 2021 Nov 9]. Available from: www.kaypahoito.fi.
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216.
https://doi.org/10.1111/j.1365-2230.1994.tb01167.x DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x
Hongbo Y, Thomas CL, Harrison MA, Salek MS, Finlay AY. Translating the science of quality of life into practice: What do dermatology life quality index scores mean? J Invest Dermatol 2005; 125: 659-664.
https://doi.org/10.1111/j.0022-202X.2005.23621.x DOI: https://doi.org/10.1111/j.0022-202X.2005.23621.x
Svedlund J, Sjodin I, Dotevall G. GSRS - a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988; 33: 129-134.
https://doi.org/10.1007/BF01535722 DOI: https://doi.org/10.1007/BF01535722
Dimenäs E, Carlsson G, Glise H, Israelsson B, Wiklund I. Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol 1996; 221: 8-13.
https://doi.org/10.3109/00365529609095544 DOI: https://doi.org/10.3109/00365529609095544
Alakoski A, Pasternack C, Reunala T, Kaukinen K, Huhtala H, Mansikka E, et al. Anaemia in dermatitis herpetiformis: prevalence and associated factors at diagnosis and one-year follow-up. Acta Derm Venereol 2021; 101: adv00443.
https://doi.org/10.2340/00015555-3795 DOI: https://doi.org/10.2340/00015555-3795
Handa S, Dabas G, De D, Mahajan R, Chatterjee D, Saika UN, et al. A retrospective study of dermatitis herpetiformis from an immunobullous disease clinic in north India. Int J Dermatol 2018; 57: 959-964.
https://doi.org/10.1111/ijd.14029 DOI: https://doi.org/10.1111/ijd.14029
Antiga E, Bonciolini V, Cazzaniga S, Alaibac M, Calabrò AS, Cardinali C, et al. Female patients with dermatitis herpetiformis show a reduced diagnostic delay and have higher sensitivity rates at autoantibody testing for celiac disease. Biomed Res Int 2019; 2019: 6307035.
https://doi.org/10.1155/2019/6307035 DOI: https://doi.org/10.1155/2019/6307035
Pasternack C, Kaukinen K, Kurppa K, Mäki M, Collin P, Hervonen K, et al. Gastrointestinal symptoms increase the burden of illness in dermatitis herpetiformis: a prospective study. Acta Derm Venereol 2017; 97: 58-62.
https://doi.org/10.2340/00015555-2471 DOI: https://doi.org/10.2340/00015555-2471
Hervonen K, Salmi TT, Ilus T, Paasikivi K, Vornanen M, Laurila K, et al. Dermatitis herpetiformis refractory to gluten-free dietary treatment. Acta Derm Venereol 2016; 96: 82-86.
https://doi.org/10.2340/00015555-2184 DOI: https://doi.org/10.2340/00015555-2184
Penny HA, Baggus EMR, Rej A, Snowden JA, Sanders DS. Non-responsive coeliac disease: A comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease. Nutrients 2020; 12: 216.
https://doi.org/10.3390/nu12010216 DOI: https://doi.org/10.3390/nu12010216
O'Leary C, Wieneke P, Buckley S, O'Regan P, Cronin CC, Quigley EMM, et al. Celiac disease and irritable bowel-type symptoms. Am J Gastroenterol 2002; 97: 1463-1467
https://doi.org/10.1111/j.1572-0241.2002.05690.x DOI: https://doi.org/10.1111/j.1572-0241.2002.05690.x
Dana ZY, Lena B, Vered R, Haim S, Efrat B. Factors associated with non adherence to a gluten free diet in adult with celiac disease: a survey assessed by BIAGI score. Clin Res Hepatol Gastroenterol 2020; 44: 762-767.
https://doi.org/10.1016/j.clinre.2019.12.014 DOI: https://doi.org/10.1016/j.clinre.2019.12.014
Errichiello S, Esposito O, Di Mase R, Camarca ME, Natale C, Limongelli MG, et al. Celiac disease: Predictors of compliance with a gluten-free diet in adolescents and young adults. J Pediatr Gastroenterol Nutr 2010; 50: 54-60.
https://doi.org/10.1097/MPG.0b013e31819de82a DOI: https://doi.org/10.1097/MPG.0b013e31819de82a
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 Camilla Pasternack, Kaisa Hervonen, Eriika Mansikka, Timo Reunala, Katri Kaukinen, Teea Salmi
![Creative Commons License](http://i.creativecommons.org/l/by-nc/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.