Can My Dermatitis Herpetiformis Go Into Remission?

dermatitis herpetiformis 'gluten rash'
The gluten rash is the itchiest rash possible. © A.D.A.M. Medical Encyclopedia

Question: I have the horribly itchy gluten rash dermatitis herpetiformis. Can it go into remission?

Answer:

Sometimes — but that doesn't mean it's a wise move to start eating gluten again if you have a diagnosis of dermatitis herpetiformis. Even if your dermatitis herpetiformis no longer is active, you still could be getting internal damage from gluten consumption.

Dermatitis herpetiformis, sometimes called the "gluten rash" or the "celiac disease rash," is an incredibly itchy, stinging rash that can occur anywhere on the body, but most frequently is found on the buttocks, elbows, knees, lower back and the back of the neck.

The skin condition eventually will go into remission if you follow a strict gluten-free diet, but there's some evidence that dermatitis herpetiformis can go into remission regardless of whether you cut out gluten.

In a study published in the Archives of Dermatology, National Institutes of Health researchers followed 86 patients with dermatitis herpetiformis for at least two years each over the course of several decades. The study reported that 10 of those patients — or 12% — had their dermatitis herpetiformis go into remission, even though some of these people were not following the gluten-free diet.

Most discovered they were in remission when they cut back on the medication Dapsone that's used to provide short-term relief from the itching and stinging associated with dermatitis herpetiformis.

The authors said the study indicates that dermatitis herpetiformis can go into remission, and that dermatologists should attempt to wean patients with "well-controlled dermatitis herpetiformis from a gluten-free diet" or from Dapsone to see if they can stay rash-free without the diet or the medication.

But is this the best idea? It's not if you have a celiac disease diagnosis.

If you have dermatitis herpetiformis along with positive blood tests for celiac disease, you have a confirmed celiac diagnosis — no further testing required. A celiac disease diagnosis means you need to follow the gluten-free diet or you'll risk complications.

Cheating on the diet, even if you have no obvious symptoms when you do, puts you at risk for a variety of serious complications.

If you never had the celiac disease blood tests or they were inconclusive, you still may risk potential internal damage if you eat gluten after a diagnosis of dermatitis herpetiformis. In the study, at least one-third of the patients who saw their rash go into remission continued to have celiac disease symptoms, and one patient developed lymphoma (it wasn't clear whether that person's dermatitis herpetiformis had gone into remission or not).

If your dermatitis herpetiformis seems to be in remission and you want to see if you can eat gluten again without symptoms, I'd recommend having a long talk with your doctor first about the potential repercussions.

Source:

S.Y. Paek et al. Remission in Dermatitis Herpetiformis: A Cohort Study. Archives of Dermatology. Published online Nov. 15, 2010. doi:10.1001/archdermatol.2010.336.

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