Dermatitis Herpetiformis: The 'Gluten Rash'

Some people call It the 'celiac disease rash,' and it's incredibly itchy

dermatitis herpetiformis
Licensed under Creative Commons/Courtesy of Dermnet

Dermatitis herpetiformis is an itchy, stinging, blistering skin rash that occurs in some people who also have celiac disease. In fact, some people call dermatitis herpetiformis the "gluten rash" or the "celiac disease rash."

Gluten is a protein that occurs in the grains wheat, barley and rye. When you have celiac disease, your body responds to ingestion of this protein by mistakenly attacking your small intestine.

If you have dermatitis herpetiformis, your immune system attacks your skin as a result of gluten ingestion.

Although dermatitis herpetiformis can form anywhere on your body, the most frequent locations include the elbows, knees, buttocks, lower back and the back of the neck. In most cases (but not all), it's one of the itchiest skin conditions you can experience.

Dermatitis Herpetiformis Symptoms

Dermatitis herpetiformis sufferers usually experience their rashes in the same location every time. The rash might be continuous, or it might come and go depending on your exposure to gluten (and possibly to other factors that haven't been isolated yet).

Before the actual dermatitis herpetiformis rash breaks out, your skin may itch in that location, or it might feel as if it's burning. The rash itself usually includes reddened skin plus multiple small, pimple-like bumps, which contain a clear liquid.

The dermatitis herpetiformis bumps usually take several days to heal (during which time new bumps usually appear nearby), and once healed, those bumps will leave behind small purple marks that last for weeks or months. People with long-standing dermatitis herpetiformis usually have continuously reddened, purple-dotted skin where their rash occurs.

Who Does Dermatitis Herpetiformis Affect?

Unlike celiac disease, which is diagnosed more often in women, dermatitis herpetiformis is more common in men. In fact, some studies show a male-to-female ratio of up to 2-to-1 in dermatitis herpetiformis patients.

Dermatitis herpetiformis had been thought to be rare in children younger than age 10, but newer research shows that it can occur in younger children. The rash often first surfaces in your teens, 20s or 30s, and it sometimes goes into remission even if you're eating a gluten-filled diet.

About 15% to 25% of people with celiac disease also have dermatitis herpetiformis. Although many of those with dermatitis herpetiformis don't have overt intestinal symptoms, 90% will have intestinal damage from gluten consumption.

Diagnosing Dermatitis Herpetiformis

Dermatitis herpetiformis is diagnosed through a skin biopsy procedure that looks for specific deposits of antibodies beneath the skin. A dermatologist usually performs the in-office procedure, which involves taking a small sample of skin.

Experts advise finding a dermatologist who's knowledgeable about dermatitis herpetiformis to perform the biopsy, since not all dermatologists are familiar with the condition or its diagnosis.

It's important to sample the skin next to an active lesion, not directly on top of the lesion, or you risk missing the telltale antibodies.

Health Risks Associated with Skin Condition

There's been comparably little research done on the health risks associated with dermatitis herpetiformis, but one study does show a risk of thinning bones that's comparable with the risk faced by those with celiac disease.

Another study found an increased risk for thyroid disease in those with dermatitis herpetiformis. This shouldn't be surprising, since celiac disease and thyroid disease often are found together.

Dermatitis Herpetiformis and Celiac Disease

In most cases, being diagnosed with dermatitis herpetiformis means you also have celiac disease, even if you don't have classic or overt intestinal celiac disease symptoms.

Some physicians aren't up on the latest research stating that dermatitis herpetiformis is the skin manifestation of celiac disease (and therefore requires a gluten-free diet). If yours isn't, you might want to consider getting a second opinion.

Treatment of Dermatitis Herpetiformis

Although a medication called dapsone can offer some initial relief from the itching associated with dermatitis herpetiformis, it carries long-term side effects. Therefore, the only long-term treatment to keep your dermatitis herpetiformis at bay is the gluten-free diet.

Controlling your dermatitis herpetiformis through diet can be difficult (you actually have to be significantly stricter to avoid skin symptoms than you do to avoid digestive symptoms from gluten). However, those who have done it say it's worth it to eliminate the constant itching.

If you can get your rash under control and into remission, any future outbreaks should be less severe (and eventually, not even particularly noticeable).

A Word from Verywell

Dermatitis herpetiformis is relatively common among those with celiac disease, but it's far from the only skin condition associated with celiac disease and antibodies to gluten. Eczema, psoriasis, alopecia areata, hives and even acne all have been linked with celiac disease.

In addition, it's certainly possible to confuse dermatitis herpetiformis with other common skin conditions. That's why it's important to see a dermatologist who is familiar with the rash and obtain a definitive diagnosis.

Sources:

Dermatitis Herpetiformis. American Osteopathic College of Dermatology.

J.A. Miller. Dermatitis Herpetiformis. eMedicine review.

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