Dermatitis herpetiformis (skin celiac disease)
What is dermatitis herpetiformis (DH) and “skin celiac disease”?
Dermatitis herpetiformis (DH) is also known as “skin celiac disease” and causes troublesome, itchy rashes when gluten is consumed. DH is a skin condition that is now considered a variant—a skin manifestation—of celiac disease. The same risk genes occur in DH as in celiac disease, but DH is much rarer than celiac disease. A few percent of people with celiac disease also have dermatitis herpetiformis. The condition is rare in children and is most often found in older adults. One hypothesis is that untreated celiac disease can develop into DH. Like celiac disease, DH is a chronic condition that currently cannot be cured.
Symptoms of dermatitis herpetiformis include skin rashes.
Dermatitis herpetiformis causes intense itching along with a rash and blistering, mainly on the elbows, forearms, knees, and buttocks. The back, neck, and scalp are also commonly affected. The rash is almost always symmetrical—that is, for example, on both the right and left elbow rather than only one side.
The skin eruptions are very distressing. Affected people often scratch the blisters open, which results in scratch marks, scabs, and sores. Many people with DH have no gastrointestinal symptoms, while others may have the same symptoms as in celiac disease. One possible explanation for the skin symptoms is that certain substances formed after an immune reaction in the small intestine are transported through the body to the skin.
Diagnosis of dermatitis herpetiformis.
To diagnose dermatitis herpetiformis, a skin biopsy is performed. The biopsy is taken from an affected area, but from skin just next to the rash, and examined to look for specific antibodies that are typical of DH. Blood tests are usually also taken to look for DH- and celiac-specific antibodies. Sometimes a small-intestinal biopsy is also performed. Even though many people with DH do not experience stomach problems, most of them have the same small-intestinal changes as in celiac disease. As with celiac disease, it is important to continue eating gluten until the medical evaluation is complete. The reason is that a gluten-free diet treats the condition, and the test results can then be falsely negative.
Treatment for dermatitis herpetiformis
Dermatitis herpetiformis is treated with a strict gluten-free diet for life. The diet must be followed very carefully. People with DH are often very sensitive to even small amounts of gluten in their diet, which can lead to skin symptoms. As a supplement to the gluten-free diet, tablets (for example dapsone) and ointments (for example steroids) may be used—especially at the beginning, before the gluten-free diet has had time to take full effect. These medications do not treat the underlying disease but can relieve the skin symptoms. The gluten-free diet is the active treatment for dermatitis herpetiformis. As with celiac disease, a gluten-free diet is a lifelong treatment for DH. Gluten cannot be absorbed through the skin, and—as with celiac disease—gluten is only harmful if it is ingested orally.
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