Cutaneous Manifestations in Celiac Disease

Celiac disease (CD) is an autoimmune, gluten-dependent enteropathy characterized by atrophy of intestinal villi that improves after a gluten-free diet (GFD). CD is often associated with extra-intestinal manifestations; among them, several skin diseases are described in CD patients. Several hypotheses have been proposed regarding the possible mechanisms involved in this association. In particular, abnormal small intestinal permeability appears to be implicated, which may allow the crossing of endogenous or exogenous antigens and may provoke the immunological response, common immune mechanisms, vascular alterations and, lastly, vitamin and amino acid deficiency secondary to malabsorption in patients with CD. However, at present the data is not homogeneous and most of the evidence for the association between CD and skin disorders is based on “case-reports”, making it difficult to draw definitive conclusions on this topic. Future controlled studies are consequently needed to verify the real involvement of the cutaneous district in CD. Nevertheless, despite these limitations, the opportunity to investigate the possible presence of CD in some dermatological patients seems at present justified.