Dermatitis herpetiformis treatment consists of a lifelong gluten-free diet, just like celiac disease. The skin’s response to the gluten-free diet is much slower compared to the healing of the intestines with celiac disease. It may take about six months to achieve some improvement in the skin condition and up to two years or more to get total control through the gluten-free diet alone. Note that skin contact with gluten-containing foods and products has not been shown to cause outbreaks.
Rash symptoms can be controlled with dapsone, an antibacterial medication. In general, itching and new lesions will begin to subside within 48-72 hours of starting this drug. However, this medication does not treat the intestinal condition; people with DH must also maintain a strict lifelong gluten-free diet to properly manage both the skin and intestinal manifestations of the disease.
Dapsone is a strong drug and may cause side effects, but with a strong adherence to the gluten-free diet many are able to use less and less as their body adjusts to the gluten-free diet. If you do not react well to dapsone, your dermatologist may recommend sulfapyridine or another topical corticosteroids.
In 2021, the European Academy of Dermatology and Venereology compiled guidelines to support dermatologists in diagnosis and treatment of DH and improve the quality of management for patients. Learn more.