BACKGROUND: A life-long gluten-free diet is the treatment of choice for 
dermatitis herpetiformis, which is considered to be coeliac disease of the skin.
OBJECTIVES: To investigate the effects on long-term remission of dermatitis 
herpetiformis in patients who underwent a gluten challenge and subsequently 
reintroduced dietary gluten.
PATIENTS AND METHODS: We studied 38 patients (14 male and 24 female) with 
biopsy-confirmed dermatitis herpetiformis. They had followed a gluten-free diet 
for a mean of 8 years, achieving clinical remission and intestinal 
normalization. The patients were asked to reintroduce gluten in their diet and 
agreed to undergo skin and intestinal biopsies during the follow-up.
RESULTS: Of the 38 patients abandoning a gluten-free diet, 31 reported the onset 
of rash within an average of 2 months. Seven subjects (three males, mean age 15 
years at challenge) experienced no clinical or histological relapses (median 
follow-up 12 years), and lost IgA immunoglobulin from the skin. The two series 
of patients differed in terms of age at diagnosis (mean age: 26.6 vs. 6 years), 
the use of dapsone (one of 31 vs. four of seven) and adherence to the 
gluten-free diet (strict compliance in 26 of 31 vs. none of seven).
CONCLUSIONS: Our data suggest that the ingestion of small doses of gluten in 
childhood and/or the use of an anti-inflammatory drug may modify the 
immunological response inducing immune tolerance. We report long-term clinical 
and histological remissions in seven patients with dermatitis herpetiformis 
after the reintroduction of dietary gluten.