Twenty-one patients with dermatitis herpetiformis have been on a gluten free 
diet regularly followed up for at least one year (mean four years). Eighteen 
patients had a 'flat' mucosal appearance (grade III), one patient had moderately 
severe mucosal abnormality (grade II), one patient had mild mucosal abnormality 
(grade I), and one patient had a normal mucosal appearance (grade O). On the 
diet, 10 patients had no skin rash and took no dapsone, seven patients 
controlled the skin rash on a lower dose of dapsone, and four noticed no 
improvement. There was no correlation between pre-diet jejunal morphology and 
response of the skin. A repeat jejunal biopsy, on the gluten free diet, was 
possible in 15 patients. While all those with skin improvement showed some 
improvement in jejunal morphology, there was no association between the degree 
of skin improvement and the degree of recovery of the jejunal mucosa.