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Ancona S, Bianchin S, Zampatti N, Nosratian V, Bigatti C, Ferro J, Trambaiolo Antonelli C, Viglizzo G, Gandullia P, Malerba F, Crocco M. Cutaneous Disorders Masking Celiac Disease: Case Report and Mini Review with Proposal for a Practical Clinical Approach. Nutrients 2023; 16:83. [PMID: 38201912 PMCID: PMC10780572 DOI: 10.3390/nu16010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Celiac disease (CD) is an immune-mediated systemic gluten-related disorder characterized by a wide spectrum of intestinal and extra-intestinal manifestations, including damage to cutaneous and connective tissue. We report a rare case of chronic severe dermatitis involving connective tissue and cutaneous vascular vessels as the main clinical presentation of undiagnosed seronegative gluten disorder. A gluten-free diet dramatically improved the intestinal and cutaneous clinical damage in the patient. Pitfalls and the steps of differential diagnosis are described. We also review the literature regarding studies of CD and connective tissue diseases to extend the knowledge of these rare associations. We propose a practical diagnostic approach in suspected CD in autoimmune cutaneous disorders.
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Affiliation(s)
- Silvana Ancona
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Silvia Bianchin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Noemi Zampatti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | | | - Carolina Bigatti
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Jacopo Ferro
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (J.F.); (C.T.A.)
| | - Chiara Trambaiolo Antonelli
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (J.F.); (C.T.A.)
| | | | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
| | - Federica Malerba
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Marco Crocco
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
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Scali E, Dastoli S, Procopio AC, Ricca D, Mazzei V, Cinaglia P, Gulletta E, Nisticò SP, Pellicano R, Alshuk N, Fagoonee S, Luzza F, Abenavoli L. Evaluation of serum calprotectin as novel biomarker in psoriatic patients: a prospective pilot study. Minerva Med 2022; 113:833-837. [PMID: 35166100 DOI: 10.23736/s0026-4806.22.08041-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory disease characterized by erythematous plaques that can extend along the entire skin surface. In the latest years, it has been shown that serum calprotectin correlated strongly with several inflammatory biomarkers. Since high levels of calprotectin have been found in psoriatic lesions, it is of paramount importance to investigate the role of serum calprotectin as a possible novel diagnostic marker of psoriasis. Aim of our prospective pilot study was to assess the level of serum calprotectin in psoriatic patients. METHODS Between January 2018 and July 2019, 45 subjects were enrolled at the Dermatology Unit of Magna Graecia University of Catanzaro, Italy. Thirty-two of them were psoriatic patients and 13 healthy controls. Psoriasis severity was assessed by the Psoriasis Area Severity Index. RESULTS A statistically significant difference between the two groups (P=0.01) was found in terms of body mass index, higher among patients than in controls. By performing the Student's t-test for unpaired data, serum calprotectin resulted significantly higher (P=0.033) among psoriatic patients than in controls. Furthermore, performing the receiver operator characteristic curve analysis, serum calprotectin showed a significant area under the curve, implying its possible role in finding psoriatic patients. Our study aimed to evaluate the serum levels of calprotectin in a group of psoriatic patients and in a control group. The results showed that serum calprotectin levels were significantly higher in the patient group than in the control group. This result confirms the observations present in the literature. CONCLUSIONS In this pilot study psoriatic patients had a significant high level of serum calprotectin than healthy subjects, and this biomarker had high accuracy in identifying patients. Further studies, with larger sample size will need to confirm our data.
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Affiliation(s)
- Elisabetta Scali
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Stefano Dastoli
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Anna C Procopio
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Daniele Ricca
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Valerio Mazzei
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Pietro Cinaglia
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Elio Gulletta
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Steven P Nisticò
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | | | | | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy
| | - Francesco Luzza
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy -
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Singh A, Ganguly S, Chhabra N, Singh V. Rare Co-Existent Dermatitis Herpetiformis and Psoriasis in a Child: A Causal Relationship? Cureus 2022; 14:e29218. [PMID: 36258965 PMCID: PMC9569416 DOI: 10.7759/cureus.29218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
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Klemm N, Gooderham MJ, Papp K. Could it be gluten? Additional skin conditions associated with celiac disease. Int J Dermatol 2021; 61:33-38. [PMID: 34212363 DOI: 10.1111/ijd.15750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022]
Abstract
Celiac disease is a multifactorial, inflammatory disorder initiated and sustained by the ingestion of gluten. Occurring across a broad population, the intestinal and extraintestinal manifestations of celiac disease are variable in severity and may be nonspecific in presentation. Given that environmental, genetic, and immune factors involved in the pathogenesis of celiac disease that the digestive tract and skin share many characteristics, and with a prevalence of 0.5-1% in most populations, it is reasonable to consider varying presentations of skin conditions that are linked with celiac disease. The association between celiac disease and skin conditions has been discussed earlier, but new studies have emerged suggesting cutaneous involvement in addition to dermatitis herpetiformis. We review the current literature identifying the relationship and potential mechanisms between celiac disease and various skin conditions.
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Affiliation(s)
- Natasha Klemm
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melinda J Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,Department of Dermatology, Queen's University, Kingston, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
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Affiliation(s)
- Ludovico Abenavoli
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy -
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Steven P Nisticò
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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Khosravi A, Kouhsar M, Goliaei B, Jayaram B, Masoudi-nejad A. Systematic analysis of genes and diseases using PheWAS-Associated networks. Comput Biol Med 2019; 109:311-21. [DOI: 10.1016/j.compbiomed.2019.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 02/08/2023]
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Lauret E, Rodrigo L. Celiac disease and autoimmune-associated conditions. Biomed Res Int 2013; 2013:127589. [PMID: 23984314 DOI: 10.1155/2013/127589] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023]
Abstract
Celiac disease (CD) is frequently accompanied by a variety of extradigestive manifestations, thus making it a systemic disease rather than a disease limited to the gastrointestinal tract. This is primarily explained by the fact that CD belongs to the group of autoimmune diseases. The only one with a known etiology is related to a permanent intolerance to gluten. Remarkable breakthroughs have been achieved in the last decades, due to a greater interest in the diagnosis of atypical and asymptomatic patients, which are more frequent in adults. The known presence of several associated diseases provides guidance in the search of oligosymptomatic cases as well as studies performed in relatives of patients with CD. The causes for the onset and manifestation of associated diseases are diverse; some share a similar genetic base, like type 1 diabetes mellitus (T1D); others share pathogenic mechanisms, and yet, others are of unknown nature. General practitioners and other specialists must remember that CD may debut with extraintestinal manifestations, and associated illnesses may appear both at the time of diagnosis and throughout the evolution of the disease. The implementation of a gluten-free diet (GFD) improves the overall clinical course and influences the evolution of the associated diseases. In some cases, such as iron deficiency anemia, the GFD contributes to its disappearance. In other disorders, like T1D, this allows a better control of the disease. In several other complications and/or associated diseases, an adequate adherence to a GFD may slow down their evolution, especially if implemented during an early stage.
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Agusti-Mejias A, Messeguer F, García-Ruiz R, de Unamuno B, Pérez-Ferriols A, Sánchez-Carazo J, Alegre de Miquel V. Concomitant Dermatitis Herpetiformis and Plaque Psoriasis: Possible Skin Manifestations of Celiac disease. Actas Dermo-Sifiliográficas (English Edition) 2011. [DOI: 10.1016/j.adengl.2010.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Agusti-Mejias A, Messeguer F, García-Ruiz R, de Unamuno B, Pérez-Ferriols A, Sánchez-Carazo J, Alegre de Miquel V. [Concomitant dermatitis herpetiformis and plaque psoriasis: possible skin manifestations of celiac disease]. Actas Dermosifiliogr 2011; 102:471-3. [PMID: 21450276 DOI: 10.1016/j.ad.2010.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/26/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022] Open
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Abstract
This review focuses on the autoimmune connective tissue diseases, endocrine, and dermatologic conditions associated with celiac disease, as well as the related gut inflammatory disorders of refractory celiac disease, autoimmune enteropathy, collagenous enteritis, and collagenous colitis.
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