Cutaneous Disorders Masking Celiac Disease: History
View Latest Version
Please note this is an old version of this entry, which may differ significantly from the current revision.
Subjects: Gastroenterology & Hepatology
Contributor:
Silvana Ancona
,
Silvia Bianchin
,
Noemi Zampatti
,
Valentina Nosratian
,
Carolina Bigatti
,
Jacopo Ferro
,
Chiara Trambaiolo Antonelli
,
Gianmaria Viglizzo
,
Paolo Gandullia
,
Federica Malerba
,
Marco Crocco

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. 

  • celiac disease
  • dermatitis herpetiformis
  • skin
  • gluten-free diet

1. Introduction

The term gluten-related disorders (GRD) refers to a spectrum of chronic disorders triggered by the ingestion of gluten, including celiac disease (CD), wheat allergy, and non-celiac gluten sensitivity (NCGS).
Celiac disease is a chronic inflammatory disorder of the small bowel that occurs in genetically susceptible individuals [1]. The diagnosis of CD is based on clinical and serological data; however, in adults, histological diagnosis is mandatory according to current guidelines [2][3]. Multiple biopsies of distal duodenum (at least four) and biopsies of the duodenal bulb (at least one, more in case of endoscopic evidence of CD) should be performed due to the possibility of patchy lesions [4] and ultra-short disease [5][6]. The HLA determination is not mandatory but might help doctors exclude CD in atypical cases due to its high negative prognostic value [2]. Less than 5% of CD patients are seronegative, i.e., present the impossibility of identifying classic serological biomarkers of CD [7]. Celiac disease has a wide spectrum of clinical manifestations: in addition to the classic gastrointestinal symptoms, it can affect a wide range of extraintestinal organs, including the skin [8]. Dermatitis herpetiformis (DH) is a gluten disorder characterized by a pruritic vesicular rash triggered by dietary gluten and characterized by deposits of immunoglobulin A (IgA) at the tips of the dermal papilla, which affects the extensor surfaces of elbows, knees, buttocks, and scalp [8]. DH is the dermatological disease most frequently associated with CD, and its treatment is a strict gluten-free diet (GFD). However, in the literature, an increased risk of other skin disorders is reported in CD, including psoriasis [9][10][11][12][13][14], alopecia areata (AA), urticaria [15][16], and vitiligo [17][18][19]. CD can also present with cutaneous signs overlapping with connective tissue disease (CTD), cutaneous vasculitis (CV), or other rare dermatological signs of malabsorption, making it more difficult to diagnose.

2. CD Skin Manifestations Overlapping with CTD

Celiac disease is a chameleonic disease [20]. It may be associated with various cutaneous disorders, ranging from the most common DH to rare cases of severe chronic dermatitis which may hide CD.

Skin diseases represent a common extra-intestinal manifestation of CD. Gluten disorders are still a diagnostic and therapeutic dilemma. Individuals with a suspected skin manifestation of SNCD should not be prescribed a GFD before concluding the mandatory investigation to rule out seronegative non-celiac diseases.

The association of CTD and CD has been reported in the literature [21][22][23], and genetic predisposition seems to play an important role. Among CTD, dermatomyositis, a rare autoimmune disease which typically affects the skin, the muscles, and the blood vessels, is the most common CTD described in association with CD [24][25][26][27]. In patients with coexisting CD and DM, a GFD may improve the cutaneous signs of DM [28].
As for systemic lupus erythematosus (SLE), Ludvigsson et al. suggested that individuals with CD have a 3-fold risk of SLE compared to the general population [29]. A recent study by Soltani et al. reported a prevalence of 3% for biopsy-proven CD in patients with SLE [30], while Shamseya et al. found biopsy-confirmed CD in 6% of juvenile SLE population [31]. Another cutaneous disorder in SLE is chilblain, also known as lupus pernio. It is usually characterized by painful papuloerythematosus plaques on the fingers due to superficial and localized inflammation resulting from a maladaptive vascular response to non-freezing cold. To the best of our knowledge, there are only three reported cases in children, all characterized by a significant improvement after adopting a GFD [32][33][34].
The association between Sjogren’s syndrome (SS) and CD has been reported in several case reports [35][36][37]. However, the prevalence of CD in patients with SS is not clear, ranging from 1% to 15% [38][39][40][41], and, in recent research, SS occurrence in CD patients varies from 1.2% to 6.5% [42][43][44][45]; this discrepancy may be due to a gap in the diagnosis of CD in SS patients. The link between CD and SS is supported by research studies that demonstrate GFD effectiveness in the control of SS symptoms in patients affected by both diseases [46].
A few publications have reported the coexistence of CD and systemic sclerosis (SSc) [47][48] with a prevalence from 4% to 8% [49][50][51], though the association between these two conditions remains controversial [52]. There is also a study that suggests a higher prevalence of CD in UCTD compared to the general population [53].
Among the overlapping symptoms, AA is an autoimmune disease common in both CD and CTD, especially SLE. The risk of alopecia is three times greater in patients with CD than in the general population [54]. Although its etiopathogenesis is still unclear, a T-cell-mediated reaction has been recognized [55], and AA may improve after starting a GFD in CD patients [56][57]. Moreover, both chronic urticaria (CU) and sclerodactily have been identified as dermatological manifestations of CD [15][16][58][59]. In a study, the odds ratio of having CD was 26.9 in patients with CU (95% CI, 6.6–110.17; p < 0.0005), compared to the control subjects [60]. Therefore, in cases of CU, CD screening should be suggested [61][62].

3. CD Skin Manifestation Overlapping with Cutaneous Vasculitis

Cutaneous vasculitis is an inflammatory process affecting the dermal blood vessel wall and leading to its destruction with subsequent ischemic and hemorrhagic events. CV is generally characterized by petechiae, palpable purpura, and infiltrated erythema [63]. The association between CD and CV has been reported in several studies [64], and the literature suggests that CV is more likely to occur in patients with poorly controlled CD and that a GFD may improve CV lesions in such cases [65][66].

4. Acrodermatitis Entheropatica Secondary to CD

A typical feature of CD is the malabsorption and subsequent deficiency of micronutrients. Among these, zinc deficiency is the most common, and it causes alopecia as well as erythematous-squamous dermatitis in the periorificial regions, genitals, and arm flexures. However, a few cases of acrodermatitis entheropatica (AE) secondary to CD have been described in the literature [67]. In these patients, cutaneous manifestations improve with a GFD and oral zinc supplement.

This entry is adapted from the peer-reviewed paper 10.3390/nu16010083

References

  1. Di Sabatino, A.; Corazza, G.R. Coeliac Disease. Lancet 2009, 373, 1480–1493.
  2. Rubio-Tapia, A.; Hill, I.D.; Semrad, C.; Kelly, C.P.; Greer, K.B.; Limketkai, B.N.; Lebwohl, B. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. Am. J. Gastroenterol. 2023, 118, 59–76.
  3. Al-Toma, A.; Volta, U.; Auricchio, R.; Castillejo, G.; Sanders, D.S.; Cellier, C.; Mulder, C.J.; Lundin, K.E.A. European Society for the Study of Coeliac Disease (ESsCD) Guideline for Coeliac Disease and Other Gluten-Related Disorders. United Eur. Gastroenterol. J. 2019, 7, 583–613.
  4. Bonamico, M.; Mariani, P.; Thanasi, E.; Ferri, M.; Nenna, R.; Tiberti, C.; Mora, B.; Mazzilli, M.C.; Magliocca, F.M. Patchy Villous Atrophy of the Duodenum in Childhood Celiac Disease. J. Pediatr. Gastroenterol. Nutr. 2004, 38, 204–207.
  5. Behl, S.; Khan, M.R.; Ismail, Y.; Swantek, C.; Chen, Z.-M.E.; Murray, J.A.; Absah, I. The Characteristics of Isolated Bulb Celiac Disease in Children. J. Pediatr. Gastroenterol. Nutr. 2023, 77, 79–85.
  6. Deb, A.; Moond, V.; Thongtan, T.; Deliwala, S.; Chandan, S.; Mohan, B.P.; Adler, D.G. Role of Duodenal Bulb Biopsy in Diagnosing Suspected Celiac Disease in Adult Patients: A Systematic Review and Meta-Analysis. J. Clin. Gastroenterol. 2023, 10, 1097.
  7. Schiepatti, A.; Biagi, F.; Fraternale, G.; Vattiato, C.; Balduzzi, D.; Agazzi, S.; Alpini, C.; Klersy, C.; Corazza, G.R. Short Article: Mortality and Differential Diagnoses of Villous Atrophy without Coeliac Antibodies. Eur. J. Gastroenterol. Hepatol. 2017, 29, 572–576.
  8. Graziano, M.; Rossi, M. An Update on the Cutaneous Manifestations of Coeliac Disease and Non-Coeliac Gluten Sensitivity. Int Rev. Immunol. 2018, 37, 291–300.
  9. Wu, J.J.; Nguyen, T.U.; Poon, K.Y.T.; Herrinton, L.J. The Association of Psoriasis with Autoimmune Diseases. J. Am. Acad. Dermatol. 2012, 67, 924–930.
  10. De Bastiani, R.; Gabrielli, M.; Lora, L.; Napoli, L.; Tosetti, C.; Pirrotta, E.; Ubaldi, E.; Bertolusso, L.; Zamparella, M.; de Polo, M.; et al. Association between Coeliac Disease and Psoriasis: Italian Primary Care Multicentre Study. Dermatology 2015, 230, 156–160.
  11. Birkenfeld, S.; Dreiher, J.; Weitzman, D.; Cohen, A.D. Coeliac Disease Associated with Psoriasis. Br. J. Dermatol. 2009, 161, 1331–1334.
  12. Abenavoli, L. Celiac Disease and Skin: Psoriasis Association. World J. Gastroenterol. 2007, 13, 2138–2139.
  13. Bhatia, B.K.; Millsop, J.W.; Debbaneh, M.; Koo, J.; Linos, E.; Liao, W. Diet and Psoriasis, Part II: Celiac Disease and Role of a Gluten-Free Diet. J. Am. Acad. Dermatol. 2014, 71, 350–358.
  14. Addolorato, G.; Parente, A.; de Lorenzi, G.; di Paola, M.E.D.A.; Abenavoli, L.; Leggio, L.; Capristo, E.; de Simone, C.; Rotoli, M.; Rapaccini, G.L.; et al. Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet: A Case Report and Review of the Literature. Digestion 2003, 68, 9–12.
  15. Caminiti, L.; Passalacqua, G.; Magazzù, G.; Comisi, F.; Vita, D.; Barberio, G.; Sferlazzas, C.; Pajno, G.B. Chronic Urticaria and Associated Coeliac Disease in Children: A Case-Control Study. Pediatr. Allergy Immunol. 2005, 16, 428–432.
  16. Ludvigsson, J.F.; Lindelöf, B.; Rashtak, S.; Rubio-Tapia, A.; Murray, J.A. Does Urticaria Risk Increase in Patients with Celiac Disease? A Large Population-Based Cohort Study. Eur. J. Dermatol. 2013, 23, 681–687.
  17. Shahmoradi, Z.; Najafian, J.; Fatemi Naeini, F.; Fahimipour, F. Vitiligo and Autoantibodies of Celiac Disease. Int. J. Prev. Med. 2013, 4, 200.
  18. Zhang, J.Z.; Abudoureyimu, D.; Wang, M.; Yu, S.R.; Kang, X.J. Association between Celiac Disease and Vitiligo: A Review of the Literature. World J. Clin. Cases 2021, 9, 10430–10437.
  19. Abenavoli, L.; Dastoli, S.; Bennardo, L.; Boccuto, L.; Passante, M.; Silvestri, M.; Proietti, I.; Potenza, C.; Luzza, F.; Nisticò, S.P. The Skin in Celiac Disease Patients: The Other Side of the Coin. Medicina 2019, 55, 578.
  20. Fasano, A. Celiac Disease-How to Handle a Clinical Chameleon. N. Engl. J. Med. 2003, 25, 2568–2570.
  21. Ma, Y.; Zhuang, D.; Qiao, Z. Dual Threat of Comorbidity of Celiac Disease and Systemic Lupus Erythematosus. J. Int. Med. Res. 2021, 49, 03000605211012258.
  22. Varkell, N.; Braester, A.; Suprun, H.; Nusem, D.; Horn, Y. Simultaneous Occurrence of Systemic Lupus Erythematosus and Coeliac Disease-like Features. Postgrad. Med. J. 1989, 65, 600–602.
  23. Boccuti, V.; Perrone, A.; D’Introno, A.; Campobasso, A.; Sangineto, M.; Sabbà, C. An Unusual Association of Three Autoimmune Disorders: Celiac Disease, Systemic Lupus Erythematosus and Hashimoto’s Thyroiditis. Autoimmun. Highlights 2016, 7, 7.
  24. Soo Song, M.; Farber, D.; Bitton, A.; Jass FRCPA DSc, J.; Singer, M.B.; Karpati, G.; Song, M.; Farber, D.; Bitton, A.; Jass, J.; et al. Dermatomyositis Associated with Celiac Disease: Response to a Gluten-Free Diet. Can. J. Gastroenterol. Hepatol. 2006, 20, 574074.
  25. Marie, I.; Lecomte, F.; Hachulla, E.; Antonietti, M.; Francois, A.; Levesque, H.; Courtois, H. An Uncommon Association: Celiac Disease and Dermatomyositis in Adults. Clin. Exp. Rheumatol. 2001, 19, 201–203.
  26. Iannone, F.; Lapadula, G. Dermatomyositis and Celiac Disease Association: A Further Case. Clin. Exp. Rheumatol. 2001, 19, 757–758.
  27. Buderus, S.; Wagner, N.; Lentze, M. Concurrence of Celiac Disease and Juvenile Dermatomyositis: Result of a Specific Immunogenetic Susceptibility? J. Pediatr. Gastroenterol. Nutr. 1997, 25, 101–103.
  28. Muddasani, S.; Rusk, A.M.; Baquerizo Nole, K.L. Gluten and Skin Disease beyond Dermatitis Herpetiformis: A Review. Int. J. Dermatol. 2021, 60, 281–288.
  29. Ludvigsson, J.F.; Rubio-Tapia, A.; Chowdhary, V.; Murray, J.A.; Simard, J.F. Increased Risk of Systemic Lupus Erythematosus in 29,000 Patients with Biopsy-Verified Celiac Disease. J. Rheumatol. 2012, 39, 1964–1970.
  30. Soltani, Z.; Baghdadi, A.; Nejadhosseinian, M.; Faezi, S.T.; Shahbazkhani, B.; Mousavi, S.A.; Kazemi, K. Celiac Disease in Patients with Systemic Lupus Erythematosus. Reumatologia 2021, 59, 85–89.
  31. Shamseya, A.M.; Elsayed, E.H.; Donia, H.M. Study of Serology and Genetics of Celiac Disease in Patients with Juvenile Systemic Lupus Erythematosus “Celiac in Juvenile Systemic Lupus”. Eur. J. Gastroenterol. Hepatol. 2020, 32, 1322–1327.
  32. Mašić, M.; Močić Pavić, A.; Gagro, A.; Balažin Vučetić, A.; Ožanić Bulić, S.; Mišak, Z. From Chilblains (Pernio) to Coeliac Disease—Should We Still Consider It Random? Children 2022, 9, 1972.
  33. Clair, N.E.S.; Choi Kim, C.; Semrin, G.; Woodward, A.L.; Liang, M.G.; Glickman, J.N.; Leichtner, A.M.; Binstadt, B.A. Celiac Disease Presenting with Chilblains in an Adolescent Girl. Pediatr. Dermatol. 2006, 23, 451–454.
  34. Lemieux, A.; Sanchez Vivas, N.E.; Powell, J.; Jantchou, P.; Morin, M.-P. Pernio as the Clinical Presentation of Celiac Disease: A Case Report. SAGE Open Med. Case Rep. 2020, 8, 2050313X2094044.
  35. D’onofrio, F.; Miele, L.; Diaco, M.; Santoro, L.; de Socio, G.; Montalto, M.; Grieco, A.; Gasbarrini, G.; Manna, R. Sjogren’s Syndrome in a Celiac Patient: Searching for Environmental Triggers. Int. J. Immunopathol. Pharmacol. 2006, 19, 445–448.
  36. Balaban, D.V.; Mihai, A.; Dima, A.; Popp, A.; Jinga, M.; Jurcut, C. Celiac Disease and Sjogren’s Syndrome: A Case Report and Review of Literature. World J. Clin. Cases 2020, 8, 4151–4161.
  37. Harpreet, S.; Deepak, J.; Kiran, B. Multiple Autoimmune Syndrome with Celiac Disease. Reumatologia 2016, 54, 326–329.
  38. Iltanen, S.; Collin, P.; Korpela, M.; Holm, K.; Partanen, J.; Polvi, A.; Mäki, M. Celiac Disease and Markers of Celiac Disease Latency in Patients with Primary Sjögren’s Syndrome. Am. J. Gastroenterol. 1999, 94, 1042–1046.
  39. Bizzaro, N.; Villalta, D.; Tonutti, E.; Doria, A.; Tampoia, M.; Bassetti, D.; Tozzoli, R. IgA and IgG Tissue Transglutaminase Antibody Prevalence and Clinical Significance in Connective Tissue Diseases, Inflammatory Bowel Disease, and Primary Biliary Cirrhosis. Dig. Dis. Sci. 2003, 48, 2360–2365.
  40. Bartoloni, E.; Bistoni, O.; Alunno, A.; Cavagna, L.; Nalotto, L.; Baldini, C.; Priori, R.; Fischetti, C.; Fredi, M.; Quartuccio, L.; et al. Celiac Disease Prevalence Is Increased in Primary Sjögren’s Syndrome and Diffuse Systemic Sclerosis: Lessons from a Large Multi-Center Study. J. Clin. Med. 2019, 8, 540.
  41. Caio, G.; de Giorgio, R.; Ursini, F.; Fanaro, S.; Volta, U. Gastroenterology and Hepatology from Bed to Bench. Prevalence of Celiac Disease Serological Markers in a Cohort of Italian Rheumatological Patients. Gastroenterol. Hepatol. Bed Bench 2018, 11, 244.
  42. Bibbò, S.; Pes, G.M.; Usai-Satta, P.; Salis, R.; Soro, S.; Quarta Colosso, B.M.; Dore, M.P. Chronic Autoimmune Disorders Are Increased in Coeliac Disease. Medicine 2017, 96, e8562.
  43. Ayar, K.; Tunç, R.; Pekel, H.; Esen, H.H.; Küçük, A.; Çifçi, S.; Ataseven, H.; Özdemir, M. Prevalence of Sicca Symptoms and Sjögren’s Syndrome in Coeliac Patients and Healthy Controls. Scand. J. Rheumatol. 2020, 49, 233–238.
  44. Erbasan, F.; Çoban, D.T.; Karasu, U.; Çekin, Y.; Yeşil, B.; Çekin, A.H.; Süren, D.; Terzioğlu, M.E. Primary Sjögren’s Syndrome in Patients with Celiac Disease. Turk. J. Med. Sci. 2017, 47, 430–434.
  45. Caglar, E.; Ugurlu, S.; Ozenoglu, A.; Can, G.; Kadioglu, P.; Dobrucali, A. Autoantibody Frequency in Celiac Disease. Clinics 2009, 64, 1195–1200.
  46. Patinen, P.; Aine, L.; Collin, P.; Hietanen, J.; Korpela, M.; Enckell, G.; Kautiainen, H.; Konttinen, Y.T.; Reunala, T. Oral Findings in Coeliac Disease and Sjögren’s Syndrome. Oral Dis. 2004, 10, 330–334.
  47. Gómez-Puerta, J.A.; Gil, V.; Cervera, R.; Miquel, R.; Jiménez, S.; Ramos-Casals, M.; Font, J. Coeliac Disease Associated with Systemic Sclerosis. Ann. Rheum. Dis. 2004, 63, 104–105.
  48. Marguerie, C.; Kaye, S.; Vyse, T.; Mackworth-Young, C.; Walport, M.J.; Black, C. Malabsorption caused by coeliac disease in patients who have scleroderma. Rheumatology 1995, 34, 858–861.
  49. Forbess, L.J.; Gordon, J.K.; Doobay, K.; Bosworth, B.P.; Lyman, S.; Davids, M.L.; Spiera, R.F. Low Prevalence of Coeliac Disease in Patients with Systemic Sclerosis: A Cross-Sectional Study of a Registry Cohort. Rheumatology 2013, 52, 939–943.
  50. Luft, L.M.; Barr, S.G.; Martin, L.O.; Chan, E.K.; Fritzler, M.J. Autoantibodies to Tissue Transglutaminase in Sjögren’s Syndrome and Related Rheumatic Diseases. J. Rheumatol. 2003, 30, 2613–2619.
  51. Rosato, E.; de Nitto, D.; Rossi, C.; Libanori, V.; Donato, G.; di Tola, M.; Pisarri, S.; Salsano, F.; Picarelli, A. High Incidence of Celiac Disease in Patients with Systemic Sclerosis. J. Rheumatol. 2009, 36, 965–969.
  52. Nisihara, R.; Utiyama, S.R.; Azevedo, P.M.; Skare, T.L. Celiac Disease Screening in Patients with Scleroderma. Arq. Gastroenterol. 2011, 48, 163–164.
  53. Conti, V.; Leone, M.C.; Casato, M.; Nicoli, M.; Granata, G.; Carlesimo, M. High Prevalence of Gluten Sensitivity in a Cohort of Patients with Undifferentiated Connective Tissue Disease. Eur. Ann. Allergy Clin. Immunol. 2015, 47, 54–57.
  54. Bondavalli, P.; Quadri, G.; Parodi, A.; Rebora, A. Failure of Gluten-Free Diet in Celiac Disease-Associated Alopecia Areata. Acta Derm. Venereol. 1998, 78, 319.
  55. Xing, L.; Dai, Z.; Jabbari, A.; Cerise, J.E.; Higgins, C.A.; Gong, W.; de Jong, A.; Harel, S.; Destefano, G.M.; Rothman, L.; et al. Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition. Nat. Med. 2014, 20, 1043–1049.
  56. Corazza, G.R.; Andreani, M.L.; Venturo, N.; Bernardi, M.; Tosti, A.; Gasbarrini, G. Celiac Disease and Alopecia Areata: Report of a New Association. Gastroenterology 1995, 109, 1333–1337.
  57. Volta, U.; Bardazzi, F.; DeFranceschi, L.; Tosti, A.; Molinaro, N.; Ghetti, S.; Tetta, C.; Grassi, A.; Bianchi, F. Serological Screening for Coeliac Disease in Vitiligo and Alopecia Areata. Br. J. Dermatol. 1997, 136, 801–802.
  58. Cooper, B.; Holmes, G.; Cooke, W. Coeliac Disease and Immunological Disorders. Br. Med. J. 1978, 1, 537–539.
  59. Zammit-Maempel, I.; Adamson’ And, A.R.; Halsey, J.P. Sclerodactyly Complicating Coeliac Disease. Rheumatology 1986, 25, 396–398.
  60. Confino-Cohen, R.; Chodick, G.; Shalev, V.; Leshno, M.; Kimhi, O.; Goldberg, A. Chronic Urticaria and Autoimmunity: Associations Found in a Large Population Study. J. Allergy Clin. Immunol. 2012, 129, 1307–1313.
  61. Kolkhir, P.; Borzova, E.; Grattan, C.; Asero, R.; Pogorelov, D.; Maurer, M. Autoimmune Comorbidity in Chronic Spontaneous Urticaria: A Systematic Review. Autoimmun. Rev. 2017, 16, 1196–1208.
  62. Caffarelli, C.; Paravati, F.; El Hachem, M.; Duse, M.; Bergamini, M.; Simeone, G.; Barbagallo, M.; Bernardini, R.; Bottau, P.; Bugliaro, F.; et al. Management of Chronic Urticaria in Children: A Clinical Guideline. Ital. J. Pediatr. 2019, 45, 101.
  63. Chen, K.-R.; Carlson, J.A. Clinical Approach to Cutaneous Vasculitis. Am. J. Clin. Dermatol. 2008, 9, 71–92.
  64. Rodrigo, L.; Beteta-Gorriti, V.; Alvarez, N.; de Castro, C.G.; de Dios, A.; Palacios, L.; Santos-Juanes, J. Cutaneous and Mucosal Manifestations Associated with Celiac Disease. Nutrients 2018, 10, 800.
  65. Meyers, S.; Dikman, S.; Spiera, H.; Schultz, N.; Janowitz, H.D. Cutaneous Vasculitis Complicating Coeliac Disease. Gut 1981, 22, 61–64.
  66. Holdstock, D.; Oleesky, S. Vasculitis in Coeliac Diseases. Br. Med. J. 1970, 4, 369.
  67. Mishra, P.; Sirka, C.S.; Das, R.R.; Nanda, D. Secondary Acrodermatitis Enteropathica-like Lesions in a Child with Newly Diagnosed Coeliac Disease. Paediatr. Int. Child Health 2016, 36, 72–75.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
This entry is offline, you can click here to edit this entry!
ScholarVision Creations
Feedback