A long-term gluten-free diet as an alternative treatment in severe forms of dermatitis herpetiformis.

Background: A long-term gluten-free diet (GFD) as a first-choice treatment for dermatitis herpetiformis (DH) has been used successfully. The aim of the present study is to evaluate the possibility of treating all severe skin manifestations of DH by a GFD only. Methods: Seventy-two patients with DH were subdivided in two groups: group A (18 patients) underwent a GFD and received dapsone; group B (54 patients) underwent a GFD. Patients were subdivided into slight, moderate and severe forms. Results: A total of 88.9% of patients treated with dapsone and a GFD (group A) had remission of skin manifestations and the remaining 11.1% were improved. In group B, 87% of patients showed complete remission of skin manifestations after 18 months of a GFD; 13% showed improvement. With regard to severe forms, after an 18-month treatment, 70.4% of patients in group B; 66.6% in group A. Conclusion: Our study shows that a GFD, if administered steadily and for a long period, can be a valid treatment for severe forms of DH. Dapsone can be useful to control the inflammatory phase of the disease.