Dermatitis herpetiformis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Overview
Dermatitis Herpetiformis (also called Duhring's disease), is a chronic itchy rash which is frequently associated with Celiac Disease. The rash is made of papules and vesicles which are present on different parts of the body mostly commonly on neck, trunk, buttocks and knees. It is an autoimmune mediated skin condition, which is IgA mediated reaction and is associated with gluten sensitivity of small bowel. There is presence of antibodies which leads to positive serology test results.
Dermatitis herpetiformis is associated with high prevalence of other autoimmune diseases.
Laboratory Findings
A skin biopsy and direct immunofluorescence test of the skin are performed in most cases; doctors may additionally recommend a biopsy of the intestines.
Skin Biopsy
It is thegold standard test in diagnosing dermatitis herpetiformis. A punch biopsy is taking from the periphery of lesion and is observed under direct immunofluorescence microscopy. The results will show granular deposits of immunoglobulin A (IgA) within the dermal papillae.
Intestinal Biopsy
A punch biopsy is ideally taken from a small intact vesicle or inflammed intestinal wall. The results depends on the age of lesion and can vary from papillary microabscess to subepidermal vesiculation. There will be greater abundance of eosinophils as compared to other bullous diseases[1]
Serology
Serology is done to confirm the diagnosis of a patient presenting dermatitis herpetiformis with underlying celiac disease. The typically tested serological markers are 1)Enzyme-linked immunosorbent assay (ELISA) for IgA tissue transglutaminase antibodies ,2)ELISA for IgA epidermal transglutaminase antibodies (when available), 3)Indirect immunofluorescence for IgA endomysial antibodies and 4) Total IgA level. The total IgA level in very important in diagnosing celiac disease in a patient who have selective IgA deficiency[2].
References
- ↑ Weedon D. The vesicobullous reaction pattern. In: Weedon's Skin Pathology, 3rd ed, Elsevier, Edinburgh 2010. p.123. no abstract available
- ↑ Bolotin D, Petronic-Rosic V. Dermatitis herpetiformis. Part II. Diagnosis, management, and prognosis. J Am Acad Dermatol. 2011 Jun;64(6):1027-33; quiz 1033-4. doi: 10.1016/j.jaad.2010.09.776. PMID: 21571168.