Dermatitis Herpetiformis—The Celiac Rash
Dermatitis herpetiformis (DH) is an unsightly and uncomfortable skin rash that affects about 15-25% of individuals with celiac disease. This type of dermatitis is called “herpetiformis” because it causes blisters that resemble a herpes outbreak. However, it is not caused by a viral infection and is not contagious. Although it can occur along with other celiac symptoms, it often shows up in people who do not have the typical intestinal problems associated with gluten intolerance. Men are more likely than women to experience DH, and Caucasians are at higher risk than other ethnic groups.
Symptoms of Dermatitis Herpetiformis
This rash often begins with an intense burning and itching sensation under the skin. The skin may appear discolored. Next, red bumps appear that usually develop into papulovesicles (blisters filled with clear fluid). They may be tiny, or up to a third of an inch in diameter. Because of the intense itching, many people with dermatitis herpetiformis scratch these blisters, causing them to crust over. Hyperpigmentation (ongoing redness or skin discoloration) may remain even after the blisters heal.
DH rash is bilaterally symmetrical, erupting in a pattern that is roughly the same size and shape on both sides of the body. The area affected may be small or large and usually involves one or more of the following locations.
- Back or neck
- Scalp and hairline
- Face (sometimes including the lips)
The first occurrence of DH usually happens during young adulthood (age 20-30). The rash is a chronic condition that may flare up and subside depending on the amount of gluten ingested.
Diagnosing Dermatitis Herpetiformis
DH can resemble many other forms of dermatitis including both irritant and allergic reactions. Since it does not respond to typical allergy treatments, proper diagnosis is essential. Diagnosis includes a blood antibody test to detect the presence of IgA, and punch biopsy to check for IgA deposits in the skin. The biopsy is taken from the skin next to a lesion and not directly from a blister since the inflammatory response can destroy the antibodies and result in a false negative.
Dermatitis Herpetiformis Treatment
The treatment of choice for DH is a drug called Dapsone. This powerful antibiotic is taken orally and usually causes substantial reduction in skin symptoms within 48-72 hours. However, because the IgA deposits in the skin aren’t eliminated, continued treatment over a period of a year or more may be required to reduce the risk of recurrence. A gluten free diet is also prescribed to limit future outbreaks.
DH is an indication of celiac disease—an autoimmune disorder that causes an inflammatory response to gluten. This condition decreases the body’s ability to digest food properly and can lead to many serious health complications. Even though people with DH are usually asymptomatic for digestive problems, damage to the intestinal tract is still occurring. This means simply treating the rash is not enough to restore health. Individuals who remove all gluten from the diet are most likely to experience remission from dermatitis herpetiformis and keep their skin clear over the long term.