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Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram Fernández-Bañares, Fernando Crespo, Laura Planella de Rubinat, Montse Farrais, Sergio Izquierdo, Sandra López-Palacios, Natalia Roy, Garbiñe Vidal, Judith Núñez, Concepción T-cell flow cytometry TCRγδ+ cells Celiac disease Celiac intraepithelial lymphogram Dermatitis herpetiformis Gluten-free diet Dermatitis herpetiformis is a cutaneous manifestation of celiac disease. Phenotyping of intraepithelial lymphocytes in the small bowel mucosa can strengthen the diagnosis of celiac disease when it is not clear-cut. We aim to evaluate the usefulness of the intraepithelial lymphogram to confirm dermatitis herpetiformis in equivocal cases. We performed a retrospective multicenter study on patients diagnosed with dermatitis herpetiformis and collected data from the intraepithelial lymphogram assessed by flow cytometry. A total of 36 patients were analyzed in relation to the severity of intestinal damage (18 had non-atrophic mucosa) at baseline (N = 28) and/or after the adoption of a gluten-free diet (median follow-up of three years, N = 16). We observed that patients with atrophy more often had positive celiac serology (p = 0.019), celiac clinical symptoms (p = 0.018), and iron-deficiency anemia (p = 0.018), but the severity of skin damage was similar in both groups (p = 0.79). At baseline, increased TCRγδ+ cells were present in 94% of patients with atrophy and 67% with non-atrophic lesions (p = 0.13). After a gluten-free diet, increased TCRγδ+ cells persisted in 100% and 63% of cases, respectively (p = 0.21). We concluded that increased TCRγδ+ cells may be helpful in confirming the diagnosis of dermatitis herpetiformis in equivocal cases, even in patients who were started on a gluten-free diet. 2024 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion https://doi.org/10.3390/nu16020232 2072-6643 https://hdl.handle.net/10459.1/465757 eng Reproducció del document publicat a: https://doi.org/10.3390/nu16020232 Nutrients, 2024, vol. 16, núm. 2 cc-by (c) authors, 2023 Attribution 4.0 International info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by/4.0/ MDPI