I appreciate the letter from Antiga et al addressing my group's study of the long-term follow-up (close to 39 years in some patients) of 86 well-documented patients with DH, 10 of whom were disease free after discontinuing both dapsone or sulfapyridine therapy and discontinuing adherence to a gluten-free diet (GFD) (12%).
Antiga et al make 2 points. First, they state that DH should not be considered a “mere skin disease ” but rather a “more complex entity with potential systemic involvement. ” I agree. Dermatitis herpetiformis is very clearly associated with CD, with 5% to 30% of patients with DH experiencing gastrointestinal signs or symptoms and the others having asymptomatic gastrointestinal disease as well as other conditions including pernicious anemia, thyroid disease, and vitiligo.1
Katz SI. Gluten-Free Diet in Patients With Dermatitis Herpetiformis: Not Only a Matter of Skin —Reply. Arch Dermatol. 2011;147(8):988–989. doi:10.1001/archdermatol.2011.222
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