Dermatitis herpetiformis (DH) is a severe, chronic skin rash associated with celiac disease.
The symptoms of dermatitis herpetiformis are extremely itchy and blistering skin. Sometimes referred to as gluten rash or celiac rash, DH is a chronic condition that is considered to be the skin form of celiac disease. Not all people with celiac disease develop DH. The rash usually occurs on the elbows, knees, and buttocks and it is typically symmetrical, meaning it appears on both sides of the body. When this gluten-related rash goes away, which it often does spontaneously, it may leave brown or pale marks on the skin where pigmentation is lost.
Skin contact with gluten-containing foods and products has not been shown to cause outbreaks. While this skin condition is officially called dermatitis herpetiformis, some people describe it as a celiac rash or a gluten rash.
Only about 20 percent of people with DH have intestinal symptoms of celiac disease, however, biopsies show that 80 percent have some degree of damage to the small intestine, especially if a high gluten diet is maintained.
Symptoms of dermatitis herpetiformis include extremely itchy skin and blisters or lesions.
DH can appear anywhere on the body. However, it most frequently presents in the following areas:
Dental defects can also be a symptom of DH. Only about 20 percent of people with DH will experience intestinal symptoms.
Doctors diagnose DH by examining the cells under the top layer of skin, known as the dermal papillae, for neutrophils and granular IgA deposits in the skin.
These types of skin samples are collected by performing a biopsy. DH can often be misdiagnosed and frequently confused with skin conditions such as allergies, bug or mosquito bites, contact dermatitis, diabetic pruritus, eczema, herpes, hives and psoriasis. While 70-80% of DH patients have higher than normal blood IgA- tTG antibody levels, a typical celiac disease blood test is not considered sufficient or reliable enough to properly diagnose patients.
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.
Rash symptoms can be controlled with 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, meaning that people with DH should also maintain a strict lifelong gluten-free diet.
DH is a skin manifestation of celiac disease and is part of the abnormal immune response to gluten. For those with celiac disease and DH, eating gluten triggers an autoimmune response which causes DH blisters to form. This rash is connected to celiac disease, not non-celiac gluten sensitivity (‘gluten sensitivity’).
DH has been known, in some cases, to go into remission, whether or not patients are adhering to a gluten-free diet. Research indicates that DH remission is both spontaneous and only experienced in a very small percentage of patients (about 12%). However, patients diagnosed with DH should NOT abandon a gluten-free diet at any time, regardless of apparent remission.
Do you or a family member suspect dermatitis herpetiformis? You may have celiac disease. Find out now. Take our Celiac Disease Symptoms Checklist.