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Dermatitis herpetiformis and bone mineral density: analysis of a French cohort of 53 patients

  • Investigative report
  • Published:
European Journal of Dermatology

Abstract

Background

The characteristics of patients with dermatitis herpetiformis (DH) in France is poorly documented. Furthermore, the risk of fractures and bone mineral density (BMD) in DH remain under-described, and recommendations for systematic screening for osteoporosis in DH are lacking.

Objectives

To describe the characteristics of DH in a large French cohort and evaluate the association between BMD and features of osteoporosis.

Materials and methods

Patients were recruited from the French Association of Gluten Intolerants (AFDIAG) and a single university dermatology department. A telephone questionnaire was used to record features of DH, history of fractures, calcium intake, treatment, and the gluten-free diet (GFD). Serum calcium and 25(OH) vitamin D3+D2 levels, as well as BMD, were measured.

Results

We included 53 patients (27 men) with a median age of 49 years (range: 23-86). Median disease duration before inclusion was 14 years (range: 2-55); 51 patients (96%) were adherent to a GFD and had no digestive symptoms. Overall, 18 (34%) had a history of fractures; 16 high-velocity (traumatic) and two low-velocity (nontraumatic). Mean BMD, measured in 48 patients, was normal (femoral neck: 0.956 ± 0.210 g/cm2; lumbar spine: 1.091 ± 1.199 g/cm2). In all, 18 patients (38%) had osteopenia and one (2%) osteoporosis. T-score for bone density did not differ with and without fractures. Calcium intake and serum calcium level were normal in all patients.

Conclusion

Screening for osteoporosis does not appear to be mandatory for DH patients with good adherence to a GFD and without digestive symptoms or additional risk factors of osteoporosis.

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References

  1. 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: 354–9.

    Article  CAS  PubMed  Google Scholar 

  2. Reunala TL. Dermatitis herpetiformis. Clin Dermatol 2001; 19: 728–36.

    Article  CAS  PubMed  Google Scholar 

  3. Ingen-Housz-Oro S. Dermatitis herpetiformis: a review. Ann Dermatol Venereol 2011; 138: 221–7.

    Article  CAS  PubMed  Google Scholar 

  4. Bolotin D, Petronic-Rosic V. Dermatitis herpetiformis. Part I. Epidemiology, pathogenesis, and clinical presentation. J Am Acad Dermatol 2011; 64: 1017–26.

    Article  PubMed  Google Scholar 

  5. Reunala T, Collin P. Diseases associated with dermatitis herpetiformis. Br J Dermatol 1997; 136: 315–8.

    Article  CAS  PubMed  Google Scholar 

  6. Alonso-Llamazares J, Gibson LE, Rogers RS. Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: review of the Mayo Clinic experience. Int J Dermatol 2007; 46: 910–9.

    Article  PubMed  Google Scholar 

  7. Hjelle AM, Apalset E, Mielnik P, Bollerslev J, Lundin KEA, Tell GS. Celiac disease and risk of fracture in adults-a review. Osteoporos Int 2014; 25: 1667–76.

    Article  CAS  PubMed  Google Scholar 

  8. Lucendo AJ, García-Manzanares A. Bone mineral density in adult coeliac disease: an updated review. Rev Esp Enferm Dig 2013; 105: 154–62.

    Article  CAS  PubMed  Google Scholar 

  9. Di Stefano M, Jorizzo RA, Veneto G, Cecchetti L, Gasbarrini G, Corazza GR. Bone mass and metabolism in dermatitis herpetiformis. Dig Dis Sci 1999; 44: 2139–43.

    Article  PubMed  Google Scholar 

  10. Abuzakouk M, Barnes L, O’Gorman N, et al. Dermatitis herpetiformis: no evidence of bone disease despite evidence of enteropathy. Dig Dis Sci 2007; 52: 659–64.

    Article  CAS  PubMed  Google Scholar 

  11. Lewis NR, Logan RFA, Hubbard RB, West J. No increase in risk of fracture, malignancy or mortality in dermatitis herpetiformis: a cohort study. Aliment Pharmacol Ther 2008; 27: 1140–7.

    Article  CAS  PubMed  Google Scholar 

  12. Lorinczy K, Juhász M, Csontos Á, et al. Does dermatitis herpetiformis result in bone loss as coeliac disease does? A cross sectional study. Rev Esp Enferm Dig 2013; 105: 187–93.

    Article  PubMed  Google Scholar 

  13. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 1994; 4: 368–81.

    Article  CAS  PubMed  Google Scholar 

  14. Gaspari AA, Huang CM, Davey RJ, Bondy C, Lawley TJ, Katz SI. Prevalence of thyroid abnormalities in patients with dermatitis herpetiformis and in control subjects with HLA-B8/-DR3. Am J Med 1990; 88: 145–50.

    Article  CAS  PubMed  Google Scholar 

  15. Cunningham MJ, Zone JJ. Thyroid abnormalities in dermatitis herpetiformis. Prevalence of clinical thyroid disease and thyroid autoantibodies. Ann Intern Med 1985; 102: 194–6.

    Article  CAS  PubMed  Google Scholar 

  16. Leonard JN, Tucker WF, Fry JS, et al. Increased incidence of malignancy in dermatitis herpetiformis. Br Med J (Clin Res Ed) 1983; 286: 16–8.

    Article  CAS  Google Scholar 

  17. Lewis HM, Renaula TL, Garioch JJ, et al. Protective effect of glutenfree diet against development of lymphoma in dermatitis herpetiformis. Br J Dermatol 1996; 135: 363–7.

    Article  CAS  PubMed  Google Scholar 

  18. Sigurgeirsson B, Agnarsson BA, Lindelöf B. Risk of lymphoma in patients with dermatitis herpetiformis. BMJ 1994; 308: 13–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Collin P, Pukkala E, Reunala T. Malignancy and survival in dermatitis herpetiformis: a comparison with coeliac disease. Gut 1996; 38: 528–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. 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: 82–6.

    Article  CAS  PubMed  Google Scholar 

  21. Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC. Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment. An Bras Dermatol 2014; 89: 865–75, quiz: 876-7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fry L. Dermatitis herpetiformis: problems, progress and prospects. Eur J Dermatol 2002; 12: 523–31.

    PubMed  Google Scholar 

  23. Tenenhouse A, Joseph L, Kreiger N, et al. Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 2000; 11: 897–904.

    Article  CAS  PubMed  Google Scholar 

  24. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 1998; 8: 468–89.

    Article  CAS  PubMed  Google Scholar 

  25. Boyanov MA. Prevalence of low central bone mineral density in a Bulgarian female referral population: a pilot study. Rheumatol Int 2006; 26: 523–9.

    Article  PubMed  Google Scholar 

  26. Pantaleoni S, Luchino M, Adriani A, et al. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. Scientific World Journal 2014; 2014: 173082.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris (APHP), Department of Dermatology, Henri Mondor Hospital, Créteil, France

    Coralie Lheure, Saskia Ingen-Housz-Oro, Pierre Wolkenstein & Oliver Chosidow

  2. EA 7379 EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), UPEC, Créteil, France

    Saskia Ingen-Housz-Oro & Oliver Chosidow

  3. Assistance Publique-Hôpitaux de Paris (APHP), Department of Rumathology, Hôpital Henri Mondor, Créteil, France

    Sandra Guignard & Xavier Chevalier

  4. Assistance Publique-Hôpitaux de Paris (APHP), Department of Rumathology, Hôpital La Pitié Salpêtrière, Paris, France

    Rachida Inaoui & Bruno Fautrel

  5. Association Française des Intolérants au Gluten, Paris, France

    Brigitte Jolivet

  6. Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France

    Pierre Wolkenstein & Oliver Chosidow

  7. GRC-UPMC 08 (EEMOIS), Institut Pierre-Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, UMPC Université Paris, Paris, France

    Bruno Fautrel

  8. Centre d’Investigation Clinique 1430, AP-HP, Créteil, France

    Oliver Chosidow

Authors
  1. Coralie Lheure
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  2. Saskia Ingen-Housz-Oro
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  3. Sandra Guignard
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  4. Rachida Inaoui
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  5. Brigitte Jolivet
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  6. Xavier Chevalier
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  7. Pierre Wolkenstein
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  8. Bruno Fautrel
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  9. Oliver Chosidow
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Corresponding author

Correspondence to Saskia Ingen-Housz-Oro.

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Lheure, C., Ingen-Housz-Oro, S., Guignard, S. et al. Dermatitis herpetiformis and bone mineral density: analysis of a French cohort of 53 patients. Eur J Dermatol 27, 353–358 (2017). https://doi.org/10.1684/ejd.2017.3029

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  • DOI: https://doi.org/10.1684/ejd.2017.3029

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