Cleveland Clinic Abu Dhabi Doctors Solve Mystery of Patient’s Unusual Rash

Rare Skin Condition Linked to Autoimmune Disease

A multidisciplinary team of specialists at Cleveland Clinic Abu Dhabi has successfully treated a patient suffering from a mysterious skin condition after discovering it was linked to celiac disease, an autoimmune disease in which people have a life-long intolerance to gluten.

The patient, a 35-year-old Emirati male, had been suffering from severe chronic blistering of his skin for more than four years before seeking treatment at Cleveland Clinic Abu Dhabi, said Dr. Mohamed Abuzakouk, a Consultant in Allergy & Immunology in the Medical Subspecialties Institute.

“This type of rash, called dermatitis herpetiformis, is a disease of people of Northern European descent and is most uncommon in Arab, Asian and African populations,” said Dr. Abuzakouk. 

The skin rash had left the patient with fluid-filled blisters on his scalp, face, and body. There was no family history of similar lesions, allergies, celiac disease or other diseases of the immune system.

A biopsy of the patient’s skin confirmed that the rash was dermatitis herpetiformis, said Dr. Abuzakouk, who was involved with the National Institute for Health and Care Excellence to develop the UK’s national guidelines for celiac disease recognition, assessment, and management.

“Genes, foods and other environmental events play a role in the development of celiac disease, an autoimmune disorder in which the immune system ‘develops’ specific antibodies and cells to attack the gut lining after exposure to gluten, a protein that is commonly found in wheat and other grains including rye and barley, damaging the small intestine,” said Dr. Abuzakouk.

Many people with celiac disease experience symptoms ranging from severe gastrointestinal problems to iron deficiency, anemia, fatigue, mouth ulcers and joint and bone pain, while others are symptom-free and are unaware they have the disease. 

“Even though the patient was not experiencing the classic gastrointestinal symptoms of gluten intolerance, the results of his detailed investigations showed strong evidence of celiac disease. He was put on medication to treat the skin rash and was also advised to follow a strict gluten-free diet as part of the long-term management of his skin condition,” said Dr. Abuzakouk.

The patient’s symptoms improved significantly shortly after commencing treatment and he is currently symptom-free. 

Cleveland Clinic Abu Dhabi’s Allergy & Immunology Program was recently recognized as a Center of Reference and Excellence in Urticaria (hives) by GA²LEN (Global Allergy and Asthma European Network) and its affiliates including the European Academy of Allergy and Clinical Immunology (EAACI). 

The program specializes in the diagnosis and management of a range of allergy-related conditions. The program’s multidisciplinary approach complements the patient’s treatment and involves a team of allergists and immunologists working with colleagues from other specialties, including gastroenterologists, dieticians, pulmonologists, ear, nose and throat specialists, dermatologists and rheumatologists.