What Is Dermatitis Herpetiformis?
If your skin feels extremely itchy or starts to blister after you eat or drink products with gluten (proteins found in grains like wheat, barley, and rye), you may have dermatitis herpetiformis (DH) or Duhring’s disease, a chronic skin condition. The underlying cause of this gluten rash is usually celiac disease, an immune disease where ingesting gluten will damage your small intestine.
When people with celiac disease eat or drink gluten, their intestine produces the antibody immunoglobulin A (IgA) — antibodies against certain enzymes that deposit in the skin. This causes white blood cells to attack your skin. As a result of this abnormal immune response to gluten, a bad skin reaction emerges.
Unlike many autoimmune diseases, the cause of DH is not a mystery. Since we know that gluten is a trigger, it allows us to use more targeted treatment. Our dermatologists at University of Utah Health can properly treat you for DH to help improve your symptoms and keep flare-ups at bay.
Dermatitis Herpetiformis Symptoms
The key symptoms of DH typically include the following:
- an extremely itchy rash with bumps or blisters,
- bumps that look like pimples,
- a symmetrical rash that occurs on both sides of your forearms, head, elbows, knees, buttocks, and hairline, and
- a rash that may come and go.
Celiac and Eczema
Dermatitis herpetiformis is frequently misdiagnosed as eczema, another inflammatory skin disorder. Both skin conditions manifest as a highly itchy and bumpy rash that people often scratch raw.
Find an Autoimmune Skin Disease Specialist
How Is Dermatitis Herpetiformis Diagnosed?
We perform a punch biopsy to confirm that DH is the problem. We inject a local anesthetic to numb the area of your skin we want to sample. Then we use a tool to make a tiny punch-hole in your skin and remove a piece of your skin for testing. We do not take samples directly from the lesions because the inflammation can destroy the IgA deposits.
Next, we use a fluorescent dye to highlight any IgA deposits that may be present. Blood tests may also be conducted to find other antibodies commonly found in people with celiac disease. Skin biopsies are highly accurate at diagnosing DH.
Dermatitis Herpetiformis Treatment
Dermatitis herpetiformis may only affect about 10-15 percent of people with celiac disease, but a strict gluten-free diet will usually resolve symptoms in time. We typically prescribe anti-inflammatory medications like dapsone to help the rash and itching subside. If you are currently taking dapsone, you should see an immediate improvement in symptoms within 48 to 72 hours.
If you cannot tolerate dapsone, we will give you another medication instead, but keep in mind that these are less effective. You may need to continue this medication regime for up to two years to help prevent future dermatitis herpetiformis outbreaks until the gluten-free diet takes effect.
People with dermatitis herpetiformis may rarely go into remission. This means that you have not showed any skin lesions or DH symptoms for more than two years while not taking medication or following a gluten-free diet.
Prognosis for Dermatitis Herpetiformis
There is no cure for dermatitis herpetiformis, however, oral medications and a gluten-free diet are extremely effective in reducing or eliminating your DH symptoms. Your symptoms will return if you consume any foods or drinks containing gluten so it is important to follow your gluten-free diet guidelines long-term.
Make An Appointment with Our Specialists
A referral is required to meet with an autoimmune skin disease specialist. However, if you have questions about a skin condition without a pre-existing diagnosis, you can schedule an appointment with a general dermatologist at the U of U Health clinic by contacting 801-581-2955.
For new patients with an existing diagnosis, you will need a referral from your current provider. Your referral should include your name, date of birth, home address, phone number, and insurance company.
Before your first appointment, records about your autoimmune history should be faxed to U of U Health at 801-581-4911. These records should include clinic notes, biopsy reports, lab reports, diagnostic studies, radiographic studies, and treatments.
Please make sure your doctor faxes your referral to:
University of Utah
Department of Dermatology
Attn: Autoimmune Clinic
Phone: 801-581-2955, ask for autoimmune scheduling
We will review referral requests within 48 hours to make sure that the best dermatologist evaluates each case. We will contact new patients about an appointment.