25 YEARS EXPERIENCE OF A GLUTEN-FREE DIET IN THE TREATMENT OF DERMATITIS-HERPETIFORMIS

Gluten-free diets have been used in the treatment of patients with der matitis herpetiformis in our department since 1967. Of the 212 patient s with dermatitis herpetiformis attending between 1967 and 1992, 133 m anaged to take the diet, and 78 of these achieved complete control of their rash by diet alone. Of the remaining 55 patients taking a gluten -free diet, all but three were taking partial diets; over half of thes e patients managed to substantially reduce the dose of medication requ ired. Of the 77 patients taking a normal diet, eight entered spontaneo us remission, giving a remission rate of 10%; a further two patients w ho had been taking gluten-free diets were found to have remitted when they resumed normal diets. Loss of IgA from the skin was observed in 1 0 of 41 (24%) patients taking strict gluten-free diets. These patients had been taking their diets for an average of 13 years (range 5-24 ye ars), and their rash had been controlled by diet alone far an average of 10 years (range 3-16 years). The advantages of a gluten-free diet i n the management of patients with dermatitis herpetiformis are: (i) th e need for medication is reduced or abolished; (ii) there is resolutio n of the enteropathy, and (iii) patients experience a feeling of well- being after commencing the diet. Thus, we propose that a gluten-free d iet is the most appropriate treatment for patients with dermatitis her petiformis.