Granular IgA Deposits in the Skin of Patients with Coeliac Disease: Is it Always Dermatitis Herpetiformis?
Veronica Bonciolini, Emiliano Antiga, Beatrice Bianchi, Elena Del Bianco, Alessandra Ninci, Vincenza Maio, Nicola Pimpinelli, Marzia Caproni
Coeliac disease is an immune-mediated enteropathy driven by gluten, which can be associated with dermatitis herpetiformis. The presence of granular IgA deposits, detected by direct immunofluorescence, is the hallmark of dermatitis herpetiformis; nevertheless, IgA deposits have also been demonstrated in healthy skin of patients with coeliac disease. The main objective of this study was to investigate whether IgA deposits could be found in the skin of patients with coeliac disease who have non-dermatitis herpetiformis inflammatory skin diseases. Direct immunofluorescence was performed on perilesional skin biopsies of 6 patients with coeliac disease with non-dermatitis herpetiformis inflammatory skin diseases and, as control, on 12 non-coeliac patients with inflammatory skin diseases. IgA deposits were found in all of the patients with coeliac disease, but were absent in the control group. In conclusion, IgA deposits may be considered an immunopathological marker for coeliac disease; therefore, patients with coeliac disease showing skin manifestations with positive direct immunofluorescence should be investigated carefully in order to make a differential diagnosis between dermatitis herpetiformis and other non-dermatitis herpetiformis inflammatory skin diseases.
Coeliac disease is a chronic enteropathy characterized by a permanent intolerance to gluten that is frequently associated with several extraintestinal conditions, including skin diseases. Dermatitis herpetiformis is the specific cutaneous manifestation of coeliac disease; however, many other dermatoses are reported in celiac patients. The immunopathologic hallmark of dermatitis herpetiformis is the presence of IgA deposits at the dermal–epidermal junction of perilesional skin as detected by direct immunofluorescence. Our study showed that such deposits can be found also in celiac patients with inflammatory skin diseases different from dermatitis herpetiformis and, therefore, could be considered as a marker of coeliac disease.