Case And Research Letter
Concomitant Dermatitis Herpetiformis and Plaque Psoriasis: Possible Skin Manifestations of Celiac disease
Coexistencia de dermatitis herpetiforme y psoriasis en placas, ¿dos manifestaciones cutáneas de la enfermedad celiaca?
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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "471" "paginaFinal" => "473" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Concomitant Dermatitis Herpetiformis and Plaque Psoriasis: Possible Skin Manifestations of Celiac disease" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 758 "Ancho" => 2000 "Tamanyo" => 322107 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A. El estudio con hematoxilina-eosina (x 20) de una de las lesiones ampollosas muestra numerosos infiltrados neutrofílicos en las papilas dérmicas y la presencia de una ampolla en la unión dermoepidérmica, sugestivos de dermatitis herpetiforme. B. La inmunofluorescencia directa de la piel sana perilesional pone de manifiesto los depósitos de IgA de forma granular en la dermis papilar, propios de la dermatitis herpetiforme.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Agusti-Mejias, F. Messeguer, R. García-Ruiz, B. de Unamuno, A. Pérez-Ferriols, J.L. Sánchez-Carazo, V. Alegre de Miquel" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Agusti-Mejias" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Messeguer" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "García-Ruiz" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "de Unamuno" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Pérez-Ferriols" ] 5 => array:2 [ "nombre" => "J.L." 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Agusti-Mejias, F. Messeguer, R. García-Ruiz, B. de Unamuno, A. Pérez-Ferriols, J.L. Sánchez-Carazo, V. Alegre de Miquel" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Agusti-Mejias" "email" => array:1 [ 0 => "annaagusti@comv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Messeguer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "García-Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "B." "apellidos" => "de Unamuno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Pérez-Ferriols" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "J.L." "apellidos" => "Sánchez-Carazo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "V." "apellidos" => "Alegre de Miquel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Coexistencia de dermatitis herpetiforme y psoriasis en placas, ¿dos manifestaciones cutáneas de la enfermedad celiaca?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 1300 "Tamanyo" => 187984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psoriatic plaques (asterisks) and multiple excoriated vesicles (arrows). The lesions are spread over the extensor surfaces of the legs and arms. A, Right elbow. B, Knees. C, Detail of right knee. D, Detail of right elbow.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Immune-mediated skin diseases are triggered by a complex interaction between individual genetic susceptibility and environmental factors. Genetic and epidemiologic data from numerous sources suggest a link between diseases that appear to have little in common, such as Crohn disease, ulcerative colitis, lichen planus, dermatitis herpetiformis, and psoriasis. One possible association that has been identified is that between psoriasis and dermatitis herpetiformis. The association is supported by the fact that both diseases share genetic polymorphisms in several immunoregulatory genes, and that patients with psoriasis have a higher prevalence of celiac disease than the general population (4.34% vs 1%-2%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old man, with mild plaque psoriasis on his elbows and knees for over 20 years but no other relevant past medical history, consulted for the progressive appearance of intensely pruritic bullous lesions around the psoriatic plaques on the extensor surfaces of his arms and legs in the previous months. Examination revealed small, symmetrically distributed, morphologically identical blisters on an erythematous base; the blisters measured 3 to 7<span class="elsevierStyleHsp" style=""></span>mm in diameter and contained a clear fluid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient reported no other symptoms related to other body systems. The rest of the skin examination was unremarkable. Hematoxylin-eosin staining of a biopsy specimen from 1 of the blisters showed numerous neutrophilic infiltrates in the dermal papillae and a blister at the dermoepidermal junction. Direct immunofluorescence study of healthy perilesional skin revealed granular deposits of immunoglobulin (Ig) A in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and biopsy of a plaque from 1 of the elbows confirmed the diagnosis of psoriasis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Laboratory tests detected anti-tissue transglutaminase antibodies at a titer of over 100; the results were negative for antiendomysial and anti-gliadin antibodies. The rest of the results, including glucose-6-phosphate dehydrogenase levels, were normal or negative. The patient was diagnosed with concomitant dermatitis herpetiformis and plaque psoriasis. Biopsy of the small intestine confirmed the diagnosis of celiac disease. The patient was started on a gluten-free diet and oral sulfone at a dose of 100 mg/day. Three months later, the bullous lesions had disappeared completely and the psoriasis score, assessed using the Psoriasis Area and Severity Index, had improved from 3 to 1.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The coexistence of plaque psoriasis lesions and dermatitis herpetiformis is rare and has only been described in anecdotal reports. Numerous authors, however, believe that there is an association between psoriasis and celiac disease. It has been observed, for example, that over 16% of patients with psoriasis have IgG and IgA anti-gliadin antibodies, IgA antitransglutaminase antibodies, and IgA antiendomysial antibodies.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Other studies have demonstrated improvements in psoriatic lesions in patients who followed a gluten-free diet, with no additional pharmacologic treatment, for 3 to 6 months.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The same patients experienced flare-ups when gluten was reintroduced to their diet. It is noteworthy that in the same study, there was no improvement in psoriasis in patients who followed the gluten-free diet but who did not have celiac disease–associated antibodies. Based on these observations,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> several authors recommend screening for celiac disease in patients with psoriasis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Psoriasis has also been associated with other IgA-mediated autoimmune diseases, namely, linear IgA pemphigus, IgA necrotic renal glomerular vasculitis, and IgA nephropathy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> One of the most interesting recent genetic findings is the increased frequency of the Ig heavy-chain HS1,2-A enhancer *2 allele in patients with dermatitis herpetiformis, plaque psoriasis, and psoriatic arthritis, suggesting a differential immune response induction in patients with psoriasis compared to the general population.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> There have also been reports of other common genetic factors (polymorphisms in the interleukin-23 receptor gene and class II human leukocyte antigen haplotypes) that are thought to predispose to an excessive or poorly regulated immune response and a chronic proinflammatory state.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Taken together, the above data support the existence of a common underlying immune disorder involving IgA dysregulation in these skin diseases. The mechanisms involved, however, are not clear.</p><p id="par0025" class="elsevierStylePara elsevierViewall">According to several authors, however, the concomitant presence of psoriasis and celiac disease (and hence dermatitis herpetiformis) is probably fortuitous due to the high prevalence of both diseases in the general population. Because most of the data supporting a possible association between celiac disease and psoriasis are derived from isolated cases, it is not possible to claim a conclusive association between the diseases. Nonetheless, the improvement seen in our patient, and in similar patients, following the adequate management of celiac disease suggests that controlled studies should be performed to investigate the true nature of the association between celiac disease and psoriasis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Agusti-Mejias A, et al. Coexistencia de dermatitis herpetiforme y psoriasis en placas, ¿dos manifestaciones cutáneas de la enfermedad celiaca? Actas Dermosifiliogr.2011;102:471-473.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 1300 "Tamanyo" => 187984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psoriatic plaques (asterisks) and multiple excoriated vesicles (arrows). The lesions are spread over the extensor surfaces of the legs and arms. A, Right elbow. B, Knees. C, Detail of right knee. D, Detail of right elbow.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 758 "Ancho" => 2000 "Tamanyo" => 322968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histology of a bullous lesion showing numerous neutrophilic infiltrates in the dermal papillae and a blister at the dermoepidermal junction (hematoxylin-eosin, original magnification x20); these 2 findings are suggestive of dermatitis herpetiformis. B, Direct immunofluorescence study of healthy perilesional skin showing granular immunoglobulin A deposits in the papillary dermis; this finding is also characteristic of dermatitis herpetiformis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 646626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology of a biopsy specimen from a psoriatic plaque on 1 of the elbows shows epidermal acanthosis, hyperkeratosis with parakeratosis, and perivascular and interstitial inflammatory infiltrates (hematoxylin-eosin, original magnification x10).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High prevalence of celiac disease in psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 17 | 10 | 27 |
| 2024 Octubre | 146 | 62 | 208 |
| 2024 Septiembre | 159 | 44 | 203 |
| 2024 Agosto | 175 | 68 | 243 |
| 2024 Julio | 165 | 47 | 212 |
| 2024 Junio | 133 | 50 | 183 |
| 2024 Mayo | 169 | 71 | 240 |
| 2024 Abril | 155 | 33 | 188 |
| 2024 Marzo | 192 | 44 | 236 |
| 2024 Febrero | 187 | 56 | 243 |
| 2024 Enero | 163 | 43 | 206 |
| 2023 Diciembre | 156 | 40 | 196 |
| 2023 Noviembre | 164 | 48 | 212 |
| 2023 Octubre | 156 | 46 | 202 |
| 2023 Septiembre | 175 | 46 | 221 |
| 2023 Agosto | 137 | 33 | 170 |
| 2023 Julio | 187 | 55 | 242 |
| 2023 Junio | 160 | 35 | 195 |
| 2023 Mayo | 215 | 44 | 259 |
| 2023 Abril | 122 | 34 | 156 |
| 2023 Marzo | 143 | 40 | 183 |
| 2023 Febrero | 124 | 37 | 161 |
| 2023 Enero | 99 | 66 | 165 |
| 2022 Diciembre | 116 | 51 | 167 |
| 2022 Noviembre | 50 | 37 | 87 |
| 2022 Octubre | 48 | 25 | 73 |
| 2022 Septiembre | 38 | 39 | 77 |
| 2022 Agosto | 93 | 39 | 132 |
| 2022 Julio | 64 | 38 | 102 |
| 2022 Junio | 62 | 30 | 92 |
| 2022 Mayo | 171 | 35 | 206 |
| 2022 Abril | 187 | 32 | 219 |
| 2022 Marzo | 181 | 58 | 239 |
| 2022 Febrero | 189 | 22 | 211 |
| 2022 Enero | 198 | 46 | 244 |
| 2021 Diciembre | 143 | 50 | 193 |
| 2021 Noviembre | 136 | 49 | 185 |
| 2021 Octubre | 133 | 57 | 190 |
| 2021 Septiembre | 107 | 56 | 163 |
| 2021 Agosto | 128 | 33 | 161 |
| 2021 Julio | 220 | 38 | 258 |
| 2021 Junio | 161 | 48 | 209 |
| 2021 Mayo | 204 | 53 | 257 |
| 2021 Abril | 414 | 98 | 512 |
| 2021 Marzo | 211 | 32 | 243 |
| 2021 Febrero | 200 | 25 | 225 |
| 2021 Enero | 130 | 12 | 142 |
| 2020 Diciembre | 153 | 22 | 175 |
| 2020 Noviembre | 125 | 16 | 141 |
| 2020 Octubre | 112 | 11 | 123 |
| 2020 Septiembre | 109 | 19 | 128 |
| 2020 Agosto | 108 | 20 | 128 |
| 2020 Julio | 100 | 19 | 119 |
| 2020 Junio | 108 | 32 | 140 |
| 2020 Mayo | 86 | 41 | 127 |
| 2020 Abril | 67 | 27 | 94 |
| 2020 Marzo | 47 | 43 | 90 |
| 2020 Febrero | 7 | 14 | 21 |
| 2020 Enero | 5 | 18 | 23 |
| 2019 Diciembre | 4 | 27 | 31 |
| 2019 Noviembre | 4 | 11 | 15 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 0 | 19 | 19 |
| 2019 Agosto | 4 | 12 | 16 |
| 2019 Julio | 4 | 27 | 31 |
| 2019 Junio | 4 | 34 | 38 |
| 2019 Mayo | 4 | 36 | 40 |
| 2019 Abril | 2 | 52 | 54 |
| 2019 Marzo | 2 | 20 | 22 |
| 2019 Febrero | 0 | 29 | 29 |
| 2019 Enero | 4 | 6 | 10 |
| 2018 Diciembre | 0 | 1 | 1 |
| 2018 Noviembre | 0 | 2 | 2 |
| 2018 Octubre | 3 | 1 | 4 |
| 2018 Septiembre | 1 | 5 | 6 |
| 2018 Agosto | 0 | 25 | 25 |
| 2018 Julio | 0 | 13 | 13 |
| 2018 Junio | 0 | 11 | 11 |
| 2018 Mayo | 0 | 11 | 11 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 7 | 7 | 14 |
| 2018 Febrero | 140 | 13 | 153 |
| 2018 Enero | 135 | 12 | 147 |
| 2017 Diciembre | 135 | 10 | 145 |
| 2017 Noviembre | 124 | 9 | 133 |
| 2017 Octubre | 117 | 9 | 126 |
| 2017 Septiembre | 116 | 11 | 127 |
| 2017 Agosto | 170 | 21 | 191 |
| 2017 Julio | 158 | 20 | 178 |
| 2017 Junio | 184 | 24 | 208 |
| 2017 Mayo | 114 | 12 | 126 |
| 2017 Abril | 124 | 14 | 138 |
| 2017 Marzo | 84 | 20 | 104 |
| 2017 Febrero | 195 | 17 | 212 |
| 2017 Enero | 99 | 17 | 116 |
| 2016 Diciembre | 138 | 13 | 151 |
| 2016 Noviembre | 203 | 20 | 223 |
| 2016 Octubre | 210 | 12 | 222 |
| 2016 Septiembre | 234 | 25 | 259 |
| 2016 Agosto | 129 | 8 | 137 |
| 2016 Julio | 100 | 1 | 101 |
| 2016 Junio | 14 | 11 | 25 |
| 2016 Mayo | 5 | 8 | 13 |
| 2016 Abril | 2 | 9 | 11 |
| 2016 Marzo | 9 | 1 | 10 |
| 2016 Febrero | 4 | 3 | 7 |
| 2016 Enero | 6 | 5 | 11 |
| 2015 Diciembre | 11 | 2 | 13 |
| 2015 Noviembre | 26 | 6 | 32 |
| 2015 Octubre | 24 | 13 | 37 |
| 2015 Septiembre | 8 | 1 | 9 |
| 2015 Agosto | 15 | 5 | 20 |
| 2015 Julio | 214 | 12 | 226 |
| 2015 Junio | 134 | 6 | 140 |
| 2015 Mayo | 154 | 9 | 163 |
| 2015 Abril | 167 | 10 | 177 |
| 2015 Marzo | 123 | 10 | 133 |
| 2015 Febrero | 121 | 11 | 132 |
| 2015 Enero | 136 | 12 | 148 |
| 2014 Diciembre | 142 | 8 | 150 |
| 2014 Noviembre | 108 | 17 | 125 |
| 2014 Octubre | 135 | 17 | 152 |
| 2014 Septiembre | 122 | 19 | 141 |
| 2014 Agosto | 122 | 20 | 142 |
| 2014 Julio | 103 | 23 | 126 |
| 2014 Junio | 144 | 13 | 157 |
| 2014 Mayo | 129 | 27 | 156 |
| 2014 Abril | 134 | 10 | 144 |
| 2014 Marzo | 162 | 14 | 176 |
| 2014 Febrero | 127 | 18 | 145 |
| 2014 Enero | 117 | 23 | 140 |
| 2013 Diciembre | 83 | 16 | 99 |
| 2013 Noviembre | 47 | 18 | 65 |
| 2013 Octubre | 49 | 15 | 64 |
| 2013 Septiembre | 59 | 19 | 78 |
| 2013 Agosto | 64 | 17 | 81 |
| 2013 Julio | 48 | 33 | 81 |
| 2013 Junio | 12 | 30 | 42 |
| 2013 Mayo | 18 | 14 | 32 |
| 2013 Abril | 12 | 21 | 33 |
| 2013 Marzo | 19 | 8 | 27 |
| 2013 Febrero | 55 | 17 | 72 |
| 2013 Enero | 72 | 6 | 78 |
| 2012 Diciembre | 41 | 5 | 46 |
| 2012 Noviembre | 1 | 0 | 1 |
| 2012 Octubre | 3 | 3 | 6 |
| 2012 Septiembre | 0 | 3 | 3 |
| 2012 Agosto | 0 | 1 | 1 |
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