Celiac is a condition in which gluten, a protein found in some grains, triggers an autoimmune response. With autoimmune conditions, the body mistakenly attacks itself. In this case, the small intestine is the target. When dermatitis herpetiformis also occurs, the skin is being attacked as well.
It is easy to mistake dermatitis herpetiformis for other skin conditions. That is why you need to undergo testing by a specialist to confirm the diagnosis and start the appropriate treatment.
This gallery of images can help you identify the signs and symptoms of dermatitis herpetiformis. It also outlines the steps a healthcare provider will take to formally diagnose you and how the condition can be treated.
Celiac disease rashGluten rash
The rash can be intensely itching and is often accompanied by a burning sensation.
The rash has distinctive reddish-purple, fluid-filled bumps, as seen here. The blisters can be as small as a pinhead or as large as a quarter-inch in size.
A dermatitis herpetiformis rash tends to come and go. During outbreaks, a person may be unable to resist scratching, which can leave behind purplish marks on the skin that can last for weeks or months.
It usually takes several days for the rash to heal, during which new bumps often develop nearby.
People with severe dermatitis herpetiformis often have continuously reddened, speckled skin where scar tissue has developed.
The rash most often develops between the ages of 30 and 40, but people of any age can be affected. Dermatitis herpetiformis had long been thought to be rare in children under 10, but more cases are being identified by researchers.
Most cases are chronic, with the frequency of outbreaks varying from one person to the next. In the majority of cases, the outbreaks will occur on the same part of the body every time.
What differentiates dermatitis herpetiformis from these other skin conditions is that it is most often symmetrical, meaning it affects both sides of the body at the same time.
Associated Skin Conditions
Dermatitis herpetiformis isn’t the only skin condition linked to celiac disease. Eczema—an itchy, scaly rash that’s common in children but also seen in adults—may be associated with both celiac disease and non-celiac gluten sensitivity.
Psoriasis—an autoimmune skin condition that leads to thick, red, scaly plaques—also shares a strong link with celiac and gluten sensitivity.
However, dermatitis herpetiformis has the strongest link with celiac disease of any skin condition. All told, between 15% to 25% of people with celiac disease also have dermatitis herpetiformis.
If you’ve been diagnosed with dermatitis herpetiformis, you almost certainly have celiac disease.
Diagnosis
Dermatitis herpetiformis is diagnosed with a combination of a blood test and skin biopsy.
The blood test looks for immune proteins, called immunoglobulin A (IgA) antibodies, that are associated with dermatitis herpetiformis.
With a biopsy, a small sample of skin is removed in a practitioner’s office. If you have dermatitis herpetiformis, the sample will show deposits of IgA in the area between the top and middle layers of skin when examined under a microscope.
In some cases, the doctor may order a biopsy of the small intestine to confirm if celiac disease is involved. This is performed in people who are not on a gluten-free diet as the diet can lead to a false-negative result.
Dermatitis herpetiformis appears to be more common in men, unlike celiac disease which is diagnosed more often in women. In fact, some studies suggest that males are twice as likely to have dermatitis herpetiformis than females.
There’s been relatively little research done on the health risks associated with dermatitis herpetiformis. Some studies show an increased risk of thinning bones comparable to that seen in people with celiac disease.
Other studies have reported an increased risk for thyroid disease—not surprising, since celiac disease and thyroid disease are often diagnosed together.
Treatment
Currently, the only long-term treatment for dermatitis herpetiformis is a gluten-free diet.
The oral antibiotic dapsone may provide short-term relief but can cause significant side effects in some people, including nausea, vomiting, dizziness, blurred vision, insomnia, ringing in the ears, and anemia.
For this reason, dapsone is used sparingly to help bring the rash under a control.
There was an error. Please try again.
The rash usually affects areas of skin on the outside of a joint (such as the knee or elbow) on both sides of the body at once. The condition can come or go but tends to affect the same body part each time. Severe cases can cause scarring and ongoing redness.
The most effective treatment for dermatitis herpetiformis is a gluten-free diet, although the oral antibiotic dapsone may help resolve the rash and relieve itching and discomfort.
A Word From Verywell
Controlling your dermatitis herpetiformis with a gluten-free diet can be difficult. Some studies suggest that you need to be even stricter if you have dermatitis herpetiformis than you do if you have celiac disease alone.
Even so, the benefits tend to be worth it. If you can get the rash into remission, any future outbreaks should be less severe and/or frequent. A certified dietitian can teach you how to be gluten-free and help you identify hidden gluten in foods.
