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Zhang JZ, Abudoureyimu D, Wang M, Yu SR, Kang XJ. Association between celiac disease and vitiligo: A review of the literature. World J Clin Cases 2021; 9:10430-10437. [PMID: 35004975 PMCID: PMC8686139 DOI: 10.12998/wjcc.v9.i34.10430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/25/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes. Vitiligo is a commonly acquired depigmentation of the skin; its clinical manifestation are skin patches caused by localized or generalized melanin deficiency. Both diseases have similar global incidence rates (approximately 1%) and are associated to similar diseases, including autoimmune bullous disease, inflammatory bowel disease, autoimmune thyroiditis, autoimmune gastritis, and type 1 diabetes. The relationship between CD and vitiligo has been reported in several studies, but their conclusions are inconsistent. Further, it has also been reported that a gluten-free diet (GFD) can improve the symptoms of immune-related skin diseases such as vitiligo. In this mini-review, we summarize and review the literature on the relationship between CD and vitiligo, assess the therapeutic significance of GFD for patients with vitiligo, and explore their possible physiopathology. We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo, thereby improving the prognosis.
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Affiliation(s)
- Jing-Zhan Zhang
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Dilinuer Abudoureyimu
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Man Wang
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Shi-Rong Yu
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Jing Kang
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
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Howard G, Horev A, Samueli B, Yerushalmi B. Morphea as Part of the Dermatological Manifestation of Celiac Disease: Case Presentation and Review of the Literature. Case Rep Dermatol 2021; 13:257-262. [PMID: 34177515 PMCID: PMC8216006 DOI: 10.1159/000514153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/02/2021] [Indexed: 01/15/2023] Open
Abstract
Celiac disease is an immune-mediated disease, affecting multiple systems and organs including several dermatological conditions. Morphea, or localized scleroderma, is also an immune-mediated condition, in which an association with celiac disease has not thus far been recognized. We present an interesting case report of a 10-year-old child with a recent diagnosis of celiac disease presenting with morphea. Following treatment and adherence to a gluten-free diet, the morphea rapidly resolved. We suggest a possible relationship between the two entities and give a brief review of the relevant literature. We suggest that morphea might be one of the many dermatological manifestations of celiac disease, with possible implications for the need to screen patients with morphea for celiac disease.
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Affiliation(s)
- Gadi Howard
- Clalit Health Services, Beer-Sheva, Israel.,Pediatric Gastroenterology Unit, Wolfson Medical Center, Holon, Israel
| | - Amir Horev
- Pediatric Dermatology Service, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benzion Samueli
- Department of Pathology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Baruch Yerushalmi
- Pediatric Gastroenterology Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Vaz SO, Franco C, Santos P, Amaral R. Skin and coeliac disease, a lot to think about: a case series. BMJ Case Rep 2018; 2018:bcr-2017-222797. [PMID: 29301808 DOI: 10.1136/bcr-2017-222797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Coeliac disease (CD) is an autoimmune disease, characterised by a permanent sensitivity to gluten. It is being progressively recognised as a multisystemic disease, with multiple extraintestinal manifestations. Skin conditions (eg, dermatitis herpetiformis) are an example of its manifestations; however, its underlying mechanisms are still not well understood. This article presents three cases of uncommon skin conditions in patients with a history of CD. Two of them concern linear IgA bullous dermatosis and erythema nodosum, which have been described in the literature as having potential associations with CD, though only a few cases were reported. The third case corresponds to pityriasis lichenoides-a rare lymphoproliferative disorder of unknown aetiology-, which has no correlation with CD in the literature reviewed. The authors aim to draw attention to the possibility of CD as a potential predisposing factor for the occurrence of these skin diseases.
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Affiliation(s)
- Sara O Vaz
- Pediatric Department, Hospital of Divino Espírito Santo of Ponta Delgada, Ponta Delgada - São Miguel, Azores, Portugal
| | - Catarina Franco
- Pediatric Department, Hospital of Divino Espírito Santo of Ponta Delgada, Ponta Delgada - São Miguel, Azores, Portugal
| | - Patrícia Santos
- Dermatology Department, Hospital of Divino Espírito Santo of Ponta Delgada, Ponta Delgada - São Miguel, Azores, Portugal
| | - Raquel Amaral
- Pediatric Department, Hospital of Divino Espírito Santo of Ponta Delgada, Ponta Delgada - São Miguel, Azores, Portugal
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Seyhan M, Erdem T, Ertekin V, Selimoğlu MA. The mucocutaneous manifestations associated with celiac disease in childhood and adolescence. Pediatr Dermatol 2007; 24:28-33. [PMID: 17300645 DOI: 10.1111/j.1525-1470.2007.00328.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study was performed to detect the prevalence of mucocutaneous manifestations of celiac disease in childhood and adolescence and to investigate the relationship between these findings and duration of disease and a gluten-free diet. The study included 55 children and adolescents with a mean age of 10.0 +/- 4.61 years (2-19 years). Mucocutaneous manifestations were evaluated with respect to age, gender, duration of illness, and of gluten-free diet and compliance with this diet. Cutaneous, mucosal, nail, and hair findings were detected in 74.5%, 27.3%, 20.0%, and 7.3% of patients, respectively. The most prevalent dermatologic diagnosis was xerosis (69.1%). No significant relationship was detected between the cutaneous findings and the duration of illness (p > 0.05). However, the duration was longer in patients with mucosal findings compared to those without mucosal findings (p < 0.05). It was found that all patients without cutaneous findings were on a strict gluten-free diet (p < 0.05). Ours is one of the few studies describing skin findings in children with celiac disease. We believe that both pediatricians and dermatologists should be aware of the various mucocutaneous manifestations of celiac disease, because a careful skin, mucosa, nail, and hair examination may lead to a diagnosis of celiac disease, particularly in atypical presentations.
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Affiliation(s)
- Muammer Seyhan
- Department of Dermatology, Medical Faculty, Inonu University, Malatya, Turkey.
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St Clair NE, Kim CC, Semrin G, Woodward AL, Liang MG, Glickman JN, Leichtner AM, Binstadt BA. Celiac disease presenting with chilblains in an adolescent girl. Pediatr Dermatol 2006; 23:451-4. [PMID: 17014640 DOI: 10.1111/j.1525-1470.2006.00281.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chilblains, or pernio, are cutaneous lesions that may accompany systemic illnesses including states of malnutrition and autoimmune diseases. We report an adolescent girl in whom chilblains were the chief presenting sign of celiac disease. A gluten-free diet led to weight gain and resolution of the chilblains. We speculate that in this patient, weight loss due to celiac disease contributed to the development of chilblains.
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Haussmann J, Sekar A. Chronic urticaria: a cutaneous manifestation of celiac disease. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2006; 20:291-3. [PMID: 16609761 PMCID: PMC2659909 DOI: 10.1155/2006/871987] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Celiac disease, or gluten-sensitive enteropathy, is an immune-mediated disease of the small bowel that results in malabsorption. It classically presents with gastrointestinal symptoms including chronic diarrhea, weight loss, abdominal bloating and anorexia. It is becoming more frequently identified in asymptomatic patients with a diagnosis of deficiencies related to malabsorption of iron, folic acid, vitamin B12 and vitamin D. It is increasingly identified as a cause for early or refractory osteoporosis. Occasionally, celiac disease presents with cutaneous manifestations alone. Dermatitis herpetiformis is a well-recognized cutaneous manifestation of celiac disease. Other cutaneous manifestations include alopecia, angular stomatitis and aphthous ulcerations. Described here is a case of a 24-year-old woman who presented with intermittent urticaria and gastrointestinal complaints. She was found to have celiac disease on small-bowel biopsy. Both her gastrointestinal symptoms and urticaria resolved when she was put on a gluten-free diet, suggesting that her urticaria was a cutaneous manifestation of celiac disease.
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Affiliation(s)
| | - Arni Sekar
- Correspondence: Dr Arni Sekar, University of Ottawa, #504–1081 Carling Avenue, Ottawa, Ontario K1Y 4G2. Telephone 613-729-3179, fax 613-729-1026, e-mail
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Spergel JM. Nonimmunoglobulin e-mediated immune reactions to foods. Allergy Asthma Clin Immunol 2006; 2:78-85. [PMID: 20525161 PMCID: PMC2876187 DOI: 10.1186/1710-1492-2-2-78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
: Adverse food reactions are abnormal responses to ingested foods. Reactions vary from immunologic to nonimmunologic immune reactions and can be either immunoglobulin E (IgE) mediated or non-IgE mediated. Food-induced IgE-mediated reactions range from localized urticaria to anaphylaxis and have been well studied. However, in comparison, there has been significantly less research into non-IgE-mediated food reactions. Non-IgE-mediated reactions can cause respiratory, gastrointestinal, and cutaneous symptoms. The most recent evidence suggests that these reactions are probably T-cell mediated as evidenced in lymphocyte proliferation assays. This review will explore the symptoms and testing methods of the most common non-IgE-mediated reactions.
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Affiliation(s)
- Jonathan M Spergel
- Assistant Professor of Pediatrics, Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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Abstract
The incidence of reporting and diagnosis of coeliac disease (CD) in children is increasing with the improvement in sensitivity and specificity of screening markers. This in turn has led to an increasing awareness of gluten-sensitive enteropathy and associated disorders. We report the unusual case of an 8-month-old child presenting to his general practitioner with pruritic skin lesions, subsequently proven to be dermatitis herpetiformis (DH) as the first sign of gluten-sensitive disease. This infant is the youngest child presenting with DH who could be identified from published report dating from 1966 onwards. Dermatitis herpetiformis is the commonest associated pathology of CD, although rare in infancy, it should be considered in any child presenting with failure to thrive and atypical, chronic rash not responding to simple measures.
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Affiliation(s)
- Daniel Lemberg
- Department of Gastroenterology, Sydney Children's Hospital, New South Wales, Australia
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Shamir R, Shoenfeld Y, Blank M, Eliakim R, Lahat N, Sobel E, Shinar E, Lerner A. The prevalence of coeliac disease antibodies in patients with the antiphospholipid syndrome. Lupus 2004; 12:394-9. [PMID: 12765303 DOI: 10.1191/0961203303lu384oa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
High prevalence of coeliac disease (CD) has been reported in various autoimmune disorders, buthas not been studied in the antiphospholipid syndrome (APS). We aimed to establish the prevalence of CD antibodies in a cohort of APS patients, and to examine whether CD may be responsible for some of the manifestations of APS. Fifty-seven patients (47 females, 10 males) with APS were studied for clinical manifestations and serological markers of the disease, as well as the presence of anti-endomysial antibodies using an ELISA assay (EMA-ELISA). Control subjects were 171 healthy individuals, age- and sex-matched (141 females). Eight patients with APS (14%, six females) were found to have EMA-ELISA antibodies, compared with 2/141 (1.1%) of controls (P = 0.0003). Antibodies against beta2-glycoprotein-I (beta2GPI) epitopes (GRTCPKPDDLP) were more prevalent in EMA-positive patients than in EMA-negative patients (P = 0.006). Vasculitic skin lesions were significantly more common in EMA-ELISA-positive compared with EMA-ELISA-negative patients(62.5 versus 16.3%, P = 0.01). Among the skin manifestations, superficial cutaneous necrosis (37.5 versus 2%, P = 0.007) was more prevalent in EMA-ELISA-positive than in EMA-ELISA-negative patients. EMA-ELISA antibodies are common in APS, and their presence is associated with high prevalence of antibodies recognizing certain beta2-glycoprotein epitopes, and with cutaneous manifestations of APS.
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Affiliation(s)
- R Shamir
- Division of Paediatric Gastroenterology and Nutrition, Meyer Children's Hospital of Haifa, Haifa, Israel.
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Abstract
We eat approximately two to three tons of food in our lifetime, but most people do not have an adverse reaction to foods. Many people believe that they have an allergic reaction to foods; however, the actual incidence confirmed by history and challenges suggests a prevalence rate closer to 2% to 8% in young infants and less than 2% in adults.
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Affiliation(s)
- Jonathan M Spergel
- Allergy Section, Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, USA.
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