Risk of Morbidity in Contemporary Celiac Disease

Nina R Lewis; Geoffrey KT Holmes


Expert Rev Gastroenterol Hepatol. 2010;4(6):767-780. 

In This Article

Dermatitis Herpetiformis

Although most, if not all, people with dermatitis herpetiformis have gluten-sensitive enteropathy, this is usually asymptomatic, and the primary manifestation is the skin lesion.[179] Earlier hospital-based case series observed that people with dermatitis herpetiformis were at increased risk of mortality and malignancy such as lymphoma, in keeping with those observations in people with celiac disease. However, these studies were limited, based on small numbers of patients typically identified from a hospital specialist clinic, and therefore unlikely to be representative of dermatitis herpetiformis in the population. A recent, large population-based study observed people with dermatitis herpetiformis were at no excess risk of death (all-cause mortality HR: 0.93 [95% CI: 0.70–1.23]), malignancy (any malignancy HR: 1.0 [95% CI: 0.73–1.49]) or indeed lymphoma (HR: 1.6 [95% CI: 0.44–6.06]) in comparison with the general population.[180] No increase in risk of cancer in people with dermatitis herpetiformis was also observed using data from the Swedish In-Patient Registry.[2] With no excess fracture risk also observed in people with dermatitis herpetiformis (any fracture HR: 1.10 [95% CI: 0.77–1.52]) compared with the general population, screening and surveillance of people with dermatitis herpetiformis for decreased BMD seems unwarranted.[180]


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