Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 6/2015

01-12-2015 | Original Research Article

Quality of Life and Gastrointestinal Symptoms in Long-Term Treated Dermatitis Herpetiformis Patients: A Cross-Sectional Study in Finland

Authors: Camilla Pasternack, Katri Kaukinen, Kalle Kurppa, Markku Mäki, Pekka Collin, Timo Reunala, Heini Huhtala, Teea Salmi

Published in: American Journal of Clinical Dermatology | Issue 6/2015

Login to get access

Abstract

Background

Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease. Both conditions are treated with a restrictive life-long gluten-free diet (GFD). Treated celiac disease patients have been shown to have more severe gastrointestinal symptoms and inferior quality of life compared with healthy controls, but evidence regarding quality of life in DH is lacking.

Objective

The aim was to evaluate whether long-term GFD-treated DH patients suffer from persistent gastrointestinal symptoms and if they experience a drawdown in quality of life.

Methods

Gastrointestinal symptoms and quality of life were assessed in 78 long-term GFD-treated DH patients using the validated Gastrointestinal Symptom Rating Scale, Psychological General Well-Being and Short Form 36 Health Survey questionnaires. The findings were compared with 110 healthy controls, population-based reference values and 371 treated celiac disease controls.

Results

The median age of the DH patients at the time of the study was 57 years, and 51 % were male. Significant differences in gastrointestinal symptoms or quality of life were not detected when treated DH patients were compared with healthy controls, but treated DH patients had less severe gastrointestinal symptoms and increased quality of life compared with celiac disease controls. Female DH patients had more severe gastrointestinal symptoms and reduced vitality compared with male DH patients. The presence of skin symptoms and the adherence to or duration of GFD did not have any influence on gastrointestinal symptoms or quality of life.

Conclusion

We conclude that long-term GFD-treated DH patients do not suffer from the burden of dietary treatment and have a quality of life comparable to that of controls.
Literature
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.CrossRefPubMed
2.
3.
Zone JJ, Meyer LJ, Petersen MJ. Deposition of granular IgA relative to clinical lesions in dermatitis herpetiformis. Arch Dermatol. 1996;132:912–8.CrossRefPubMed
4.
Collin P, Reunala T. Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists. Am J Clin Dermatol. 2003;4:13–20.CrossRefPubMed
5.
6.
Reunala T, Blomqvist K, Tarpila S, Halme H, Kangas K. Gluten-free diet in dermatitis herpetiformis. I. Clinical response of skin lesions in 81 patients. Br J Dermatol. 1977;97:473–80.CrossRefPubMed
7.
Fry L, Riches DJ, Seah PP, Hoffbrand AV. Clearance of skin lesions in dermatitis herpetiformis after gluten withdrawal. Lancet. 1973;301:288–91.CrossRef
8.
Lewis HM, Renaula TL, Garioch JJ, et al. Protective effect of gluten-free diet against development of lymphoma in dermatitis herpetiformis. Br J Dermatol. 1996;135:363–7.CrossRefPubMed
9.
Sverker A, Ostlund G, Hallert C, Hensing G. ‘I lose all these hours…’—exploring gender and consequences of dilemmas experienced in everyday life with coeliac disease. Scand J Caring Sci. 2009;23:342–52.CrossRefPubMed
10.
Black JL, Orfila C. Impact of coeliac disease on dietary habits and quality of life. J Hum Nutr Diet. 2011;24:582–7.CrossRefPubMed
11.
Zarkadas M, Dubois S, MacIsaac K, et al. Living with coeliac disease and a gluten-free diet: a Canadian perspective. J Hum Nutr Diet. 2013;26:10–23.CrossRefPubMed
12.
Ukkola A, Maki M, Kurppa K, et al. Diet improves perception of health and well-being in symptomatic, but not asymptomatic, patients with celiac disease. Clin Gastroenterol Hepatol. 2011;9:118–23.CrossRefPubMed
13.
Nachman F, Maurino E, Vazquez H, et al. Quality of life in celiac disease patients: prospective analysis on the importance of clinical severity at diagnosis and the impact of treatment. Digest Liver Dis. 2009;41:15–25.CrossRef
14.
Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M. Gluten-free diet and quality of life in patients with screen-detected celiac disease. Eff Clin Pract. 2002;5:105–13.PubMed
15.
Hauser W, Gold J, Stein J, Caspary WF, Stallmach A. Health-related quality of life in adult coeliac disease in Germany: results of a national survey. Eur J Gastroenterol Hepatol. 2006;18:747–54.CrossRefPubMed
16.
Usai P, Minerba L, Marini B, et al. Case control study on health-related quality of life in adult coeliac disease. Digest Liver Dis. 2002;34:547–52.CrossRef
17.
Fera T, Cascio B, Angelini G, Martini S, Guidetti CS. Affective disorders and quality of life in adult coeliac disease patients on a gluten-free diet. Eur J Gastroenterol Hepatol. 2003;15:1287–92.CrossRefPubMed
18.
Midhagen G, Hallert C. High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study. Am J Gastroenterol. 2003;98:2023–6.CrossRefPubMed
19.
Paarlahti P, Kurppa K, Ukkola A, et al. Predictors of persistent symptoms and reduced quality of life in treated coeliac disease patients: a large cross-sectional study. BMC Gastroenterol. 2013;13:75.PubMedCentralCrossRefPubMed
20.
Aalto A-M, Aro AR, Teperi J. RAND-36 terveyteen liittyvän elämänlaadun mittarina- mittarin luotettavuus ja suomalaiset väestöarvot. Stakes: Helsinki; 1999.
21.
Svedlund J, Sjodin I, Dotevall G. GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Digest Dis Sci. 1988;33:129–34.CrossRefPubMed
22.
Dimenas E, Carlsson G, Glise H, Israelsson B, Wiklund I. Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol Suppl. 1996;221:8–13.CrossRefPubMed
23.
Ware JE Jr, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol. 1998;51:903–12.CrossRefPubMed
24.
Roos S, Karner A, Hallert C. Psychological well-being of adult coeliac patients treated for 10 years. Digest Liver Dis. 2006;38:177–80.CrossRef
25.
Hallert C, Granno C, Grant C, et al. Quality of life of adult coeliac patients treated for 10 years. Scand J Gastroenterol. 1998;33:933–8.CrossRefPubMed
26.
Holm EA, Wulf HC, Stegmann H, Jemec GB. Life quality assessment among patients with atopic eczema. Br J Dermatol. 2006;154:719–25.CrossRefPubMed
27.
Lundberg L, Johannesson M, Silverdahl M, Hermansson C, Lindberg M. Health-related quality of life in patients with psoriasis and atopic dermatitis measured with SF-36, DLQI and a subjective measure of disease activity. Acta Derm Venereol. 2000;80:430–4.CrossRefPubMed
28.
Boehncke WH, Menter A. Burden of disease: psoriasis and psoriatic arthritis. Am J Clin Dermatol. 2013;14:377–88.CrossRefPubMed
29.
Paavola A, Kurppa K, Ukkola A, et al. Gastrointestinal symptoms and quality of life in screen-detected celiac disease. Digest Dis Sci. 2012;44:814–8.CrossRef
30.
Ilus T, Lähdeaho ML, Salmi T, et al. Persistent duodenal intraepithelial lymphocytosis despite a long-term strict gluten-free diet in celiac disease. Am J Gastroenterol. 2012;107:1563–9.CrossRef
31.
Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004;79:669–73.PubMed
32.
Faulkner-Hogg KB, Selby WS, Loblay RH. Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol. 1999;34:784–9.CrossRefPubMed
33.
Fuchs V, Kurppa K, Huhtala H, Collin P, Maki M, Kaukinen K. Factors associated with long diagnostic delay in celiac disease. Scand J Gastroenterol. 2014;49:1304–10.PubMed
34.
Wacklin P, Kaukinen K, Tuovinen E, et al. The duodenal microbiota composition of adult celiac disease patients is associated with the clinical manifestation of the disease. Inflamm Bowel Dis. 2013;19:934–41.CrossRefPubMed
35.
O’Leary C, Wieneke P, Buckley S, et al. Celiac disease and irritable bowel-type symptoms. Am J Gastroenterol. 2002;97:1463–7.CrossRefPubMed
36.
Herman J, Pokkunuri V, Braham L, Pimentel M. Gender distribution in irritable bowel syndrome is proportional to the severity of constipation relative to diarrhea. Gen Med. 2010;7:240–6.CrossRef
37.
Hallert C, Granno C, Hulten S, et al. Living with coeliac disease: controlled study of the burden of illness. Scand J Gastroenterol. 2002;37:39–42.CrossRefPubMed
38.
Tontini GE, Rondonotti E, Saladino V, Saibeni S, de Franchis R, Vecchi M. Impact of gluten withdrawal on health-related quality of life in celiac subjects: an observational case–control study. Digestion. 2010;82:221–8.CrossRefPubMed
Metadata
Title
Quality of Life and Gastrointestinal Symptoms in Long-Term Treated Dermatitis Herpetiformis Patients: A Cross-Sectional Study in Finland
Authors
Camilla Pasternack
Katri Kaukinen
Kalle Kurppa
Markku Mäki
Pekka Collin
Timo Reunala
Heini Huhtala
Teea Salmi
Publication date
01-12-2015
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 6/2015
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-015-0149-1

Other articles of this Issue 6/2015

American Journal of Clinical Dermatology 6/2015 Go to the issue

Review Article

The Safety and Efficacy of Narrow Band Ultraviolet B Treatment in Dermatology: A Review

Review Article

Prurigo Pigmentosa: Literature Review

Leading Article

New and Emerging Treatments for Rosacea

Review Article

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: An Update

Review Article

Granular Parakeratosis: A Comprehensive Review and a Critical Reappraisal

Review Article

Alternative Systemic Treatments for Vitiligo: A Review