The falling incidence and prevalence of dermatitis herpetiformis

Conflicts of interest None declared. Professor Timo Reunala’s dermatology department at Tampere has the largest collection of patients with dermatitis herpetiformis (DH). They have made significant contributions to the study of DH over the years. They now report on the falling prevalence and incidence of the disease.1 It is now accepted that all patients with DH have coeliac disease. It was pointed out in 19722 that patients with DH have varying degrees of enteropathy. These investigators showed that, even if the gross morphology of the intestinal mucosa was normal, these patients had significantly raised intraepithelial lymphocyte counts and they described these patients as having mild coeliac disease. The concept of mild coeliac disease was not accepted by the gastroenterologists for another 20 years, until the studies of Marsh in 1992,3 who showed that the first stage of mucosal pathology in coeliac disease was infiltration of the intestinal mucosa with lymphocytes.