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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The investigation of dermatitis herpetiformis should include the following:

  • blood tests for celiac disease
    • immunology study
    • IgA antiendomysial antibodies
    • IgA anti-tissue transglutaminase antibodies (sensitivity 98.5%, specificity 98%)
    • useful additional test if serology supports the diagnosis of coeliac disease include
      • FBC
      • blood film
      • haematinics (vitamin B12, folate, ferritin)
      • urea and electrolytes may
      • thyroid function test – due to the association of thyroid disease with both coeliac disease and dermatitis herpetiformis
    • skin biopsies
      • lesional skin of patients with DH will reveal epidermal vesicles and blisters associated with accumulation of neutrophils at the papillary tips on histopathological study
      • a second biopsy consisting of peri-lesional skin (within 2cm of the blister) is used for direct immunofluorescence
        • is the gold standard for the diagnosis of DH
        • will show granular IgA deposits along the dermal-epidermal junction and on top of the dermal papillae

If blood tests point towards a diagnosis of celiac disease, a referral to secondary care is recommended.

Note:

  • once the diagnosis is confirmed, DH should be considered as a cutaneous manifestation of and pathognomonic for, coeliac disease. Hence, duodenal or jejunal biopsies are not considered necessary for further diagnosis

Reference:


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