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Dermatitis Herpetiformis

Dermatitis Hereptiformis Celiac Rash PictureDermatitis 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.

Who Gets Dermatitis Herpetiformis?

  • About 15-25% of individuals with celiac disease experience DH
  • Dermatitis herpetiformis affects more men than women
  • Dermatitis herpetiformis generally starts in adulthood. It’s not common to see DH in children, but it can occur

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.

Dermatitis Herpetiformis Symptoms

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:

  • Buttocks
  • Elbows
  • Knees
  • Lower back
  • Scalp

Dental defects can also be a symptom of DH. Only about 20 percent of people with DH will experience intestinal symptoms.

Diagnosing Dermatitis Herpetiformis

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.

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.

Dermatitis Herpetiformis Treatment

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.

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.

Dermatitis Herpetiformis and Celiac Disease

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’).

Dermatitis Herpetiformis Remission

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.

Learn More About Dermatitis Herpetiformis

Do you or a family member suspect dermatitis herpetiformis? You may have celiac disease. Find out now. Take our Celiac Disease Symptoms Checklist.


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