Dermatitis Herpetiformis (The Celiac Rash)

An Overview of Dermatitis Herpetiformis

Gluten intolerance gives rise to several health complications, including issues with skin rashes and acne. Dermatitis herpetiformis is one such rash. It is basically a celiac disease of the skin or celiac disease rash. While it is usually the internal symptoms of gluten intolerance that get the most attention, dermatitis herpetiformis is a serious complication of gluten that we must all be aware of.

What is Dermatitis Herpetiformis?

Dermatitis Herpetiformis (The Celiac Rash) herpetiformis is a blistering skin rash that results from consuming gluten. This rash is incredibly itchy and sufferers often describe it as maddening. It is so itchy that it can wake someone up from their sleep. 

Dermatitis herpetiformis is an autoimmune disease, causing the immune system to attack your skin as a result of gluten intolerance.

The word herpetiformis indicates that the rash resembles herpes lesions, but the herpes virus is not causing the rash itself. It is also referred to as Duhring’s Disease, named after Louis Adolphus Duhring who first classified it in 1884. Many often simply call it the gluten rash.

Dermatitis herpetiformis affects about 15-25 percent of people who have celiac disease. There is a strong correlation between the two; however, it is possible to experience an outbreak of dermatitis herpetiformis without having experienced internal symptoms from celiac disease before. Likewise, it is possible (and even common) to have dermatitis herpetiformis but have a negative celiac blood test.

If you have dermatitis herpetiformis, there is a 90 percent chance you also have intestinal damage regardless of whether you have symptoms.

If you have celiac disease, you don’t necessarily have dermatitis herpetiformis, but if you have dermatitis herpetiformis, you do have celiac.

Dermatitis herpetiformis is usually onset in adulthood, usually between the ages of 30 to 40. It rarely occurs in children. It is twice as likely to occur in men.

What are the Dermatitis Herpetiformis Symptoms?

Dermatitis herpetiformis rashes are usually extremely uncomfortable and can be painful. Many will say it may be the worst rash you will ever experience. The gluten rash can crop up anywhere on your body, however it does have a list of places it frequents, such as:

  • Face
  • Scalp and hairline
  • Back of the neck
  • Lower back
  • Buttocks
  • Elbows
  • Knees
  • Legs
Severe Dermatitis Herpetiformis on the belly

Severe Dermatitis Herpetiformis on the belly

Before the rash appears, you may feel intense burning and itching on the area where it is about to form. Next, watery blisters and red bumps will form. These bumps may last for several days while they heal, during which time new ones may form.

Dealing with the itching is the biggest challenge to face while dealing with a dermatitis herpetiformis breakout. This can lead to breaking the blisters, bleeding, scarring and skin discoloration.

The rash is so intense that many sufferers can only find relief in scratching. Some have said they scratch so hard they bleed!

Unfortunately, doctors can misdiagnose dermatitis herpetiformis several other conditions, leading to repeat occurrences and finding no relief from the itch. The only way to control dermatitis herpetiformis is with a gluten free diet. Finding a doctor to examine your rash is an important step towards finding proper treatment.

How is Dermatitis Herpetiformis Diagnosed?

Since dermatitis herpetiformis can be easily misdiagnosed, there is a key that dermatologists must look for to determine if they’re dealing with the gluten rash. In this case, when you digest gluten, the intestine produces an antibody called immunoglobulin A (IgA). IgA then enters the bloodstream and collects in small blood vessels under the skin. This gives rise to the gluten rash. It is this antibody pattern that dermatologists look for by taking a skin biopsy of the skin near the rash.

When working with a dermatologist it is important to make sure they are familiar with diagnosing dermatitis herpetiformis (many are not). They must be familiar with the condition. Skin samples from the rash site may provide inconclusive results as inflammation around the rash site may destroy the IgA within.

Dermatitis Herpetiformis

Dermatitis Herpetiformis

The procedure for taking a biopsy of the rash usually happens in-office and it is quite simple. The dermatologist applies a local anesthetic to the area to be biopsied. To test for dermatitis herpetiformis, she will use a “punch biopsy” wherein she will remove a 4 millimeter sample of skin with a small device resembling a cookie cutter. The derma usually closed the sample site with one stitch and it quickly heals. After that, she will dye and examine the biopsy sample for any IgA deposits.

Many people have suffered with dermatitis herpetiformis for many years. They stumble upon information that gluten could be causing it. In their excitement and desperation, rather than waiting to be seen by a dermatologist, they immediately cut gluten out of their diet. If the rash improves, it very well may be dermatitis herpetiformis, especially if the rash worsens upon reintroducing gluten. Still, the only way to confirm the diagnosis is through biopsy.

How is Dermatitis Herpetiformis Treated?

Once you have a confirmed dermatitis herpetiformis diagnosis, your doctor may prescribe you something to help contend with the burning itch for short-term. However, to prevent the rash from returning, and to get the upper hand on it, cultivating a gluten-free diet is the only treatment that it will respond to.

Dermatitis Herpetiformis on the Shoulder

Dermatitis Herpetiformis on the Shoulder

The doctor may prescribe the medication dapsone, an oral antibiotic, to help control the itch and prevent further damage to the skin through scratching. However, this medication can lead to some serious side effects, so it is not recommended for long-term use. It is best to avoid it altogether whenever possible.

Dapsone can also lead to blood and liver problems, so your doctor may require frequent blood tests to monitor your health if you do take this medication. There are few alternative medications to dapsone, with a gluten free diet being the only true long-term treatment option.

Going gluten-free can be tough for those new to the idea. However, the thought of ridding themselves of and preventing the gluten rash is enough to make the change worth it. Going gluten free is both a long-term treatment option and preventative measure when it comes to dermatitis herpetiformis.

Dermatitis Herpetiformis on the Knees and Legs

Dermatitis Herpetiformis on the Knees and Legs

How is Dermatitis Herpetiformis Connected to Celiac Disease?

We’ve already mentioned the connection between the gluten rash and its internal counterpart celiac disease, but exactly how are they related? Does a diagnosis of dermatitis herpetiformis mean that you also have celiac disease as well?

The exact answer may differ from doctor to doctor, with some viewing the burning rash as a symptom of celiac disease, and others classifying it as a condition of its own. In some cases, dermatitis herpetiformis may even present with symptoms of celiac disease, such as abdominal pain, fatigue, bloating, constipation, or diarrhea.

Dermatitis Herpetiforme 3

Dermatitis Herpetiformis on the Feet.

It is also good to note that both celiac disease and dermatitis herpetiformis are autoimmune diseases. This means that when gluten you consume gluten, the body’s immune system reacts by attacking the healthy cells.

Dermatitis herpetiformis is typically considered a form of celiac disease, although not everyone with celiac disease will develop dermatitis herpetiformis.

While celiac disease causes damage to the lining of the small intestine, dermatitis herpetiformis attacks healthy skin with the eruption of the painful rash. Looking at them both this way makes it easy to see how they are related. Banishing gluten from your diet is the treatment for eliminating the symptoms of both these conditions and preventing any further complications they may bring about.

Are There any Complications from Dermatitis Herpetiformis?

The most obvious complications that arise from dermatitis herpetiformis are the same that would arise from any terrible rash. Scaring from scratching lesions is a very real possibility, given the intensity of the itch, as well as skin discoloration.

If taking medication such as dapsone, there are other risks to watch out for. This includes increased photosensitivity and other side effects.

Dermatitis Herpetiformis

Dermatitis Herpetiformis on the abdomen.

Likewise, if hidden symptoms of intestinal celiac disease are transpiring unbeknownst to the patient, this can be very serious. This would include intestinal damage and a lack of proper nutrient absorption leading to a host of physical problems.

There are not many issues that dermatitis herpetiformis leads to on its own. However, its autoimmune status can be an indicator that other health conditions to be aware of may be lurking beneath the surface.

Since celiac disease and dermatitis herpetiformis are both autoimmune diseases, the chances of a person who has one or both conditions developing another autoimmune condition increases. Gluten has been linked with diseases such as thyroid disorders and Type 1 diabetes.

Going Gluten-Free for Life: The Best Treatment Option

Foregoing gluten is the best way to get an edge on dermatitis herpetiformis and the complications from celiac disease. It will have to be a life-long commitment to ensure that your health remains in good shape. If you’ve ever experienced a rash like dermatitis herpetiformis, then you’ll agree that a lifelong avoidance of gluten is a small price to pay in order to stay itch-free.