Dermatitis Herpetiformis

Dermatitis Herpetiformis Itches with a capital “I”! How is this skin rash related to gluten?

Here's how Dermatitis Herpetiformis is defined by the The Oslo definitions for coeliac disease and related terms: “a cutaneous manifestation of small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten.” In other words, Dermatitis Herpetiformis is an outward sign (“manifestation”) on the skin (“cutaneous”) of damage and disease (“enteropathy”) that happens because a person has an immune (“immune-mediated”) response to “dietary gluten.”

The Dermatitis Herpetiformis rash usually appears as clusters, especially on elbows or knees but also commonly on shoulders or buttocks. It's sometimes described as “bumps” or “blisters.”

Dermatitis Herpetiformis affects about 1 person in 10,000, far fewer than the percentage of people with Celiac Disease or Non-Celiac Gluten Sensitivity.

Most (but not all) people diagnosed with Dermatitis Herpetiformis also are diagnosed with Celiac Disease. People with Dermatitis Herpetiformis generally have the same genetic vulnerability as those with Celiac Disease. Similar associations with other autoimmune conditions is reported for both groups.

Q: How is Dermatitis Herpetiformis diagnosed? 

A dermatologist can diagnose Dermatitis Herpetiformis when the rash is present by taking a skin biopsy. Among other characteristics, Dermatitis Herpetiformis is associated with IgA antibodies, in this case directed against eTG, transglutaminase in the outer layer of the skin. Dermatitis Herpetiformis lesions also shows signs of inflammation from certain white blood cells.

Q: How can someone with Dermatitis Herpetiformis make the itching disappear and the skin rash go away? 

Dermatitis Herpetiformis, like Celiac Disease, responds to the gluten free diet. For many of those affected, the gluten free diet resolves their situation.

For some Dermatitis Herpetiformis patients, neutrophils (one type of the white blood cells that cause inflammation) remain localized in the skin despite a gluten free diet, Dermatologists can prescribe Dapsone to inhibit neutrophil activity.

For more information, see celiac disease, gluten free and gluten free diet.

Contact us for more information about Dermatitis Herpetiformis.