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Dermatitis herpetiformis (DH) is a chronic disease of the skin
marked by groups of watery, itchy blisters that may resemble pimples
or blisters. The ingestion of gluten (from wheat, rye, and barley)
triggers an immune system response that deposits a substance, lgA
(Immunoglobulin A), under the top layer of skin. IgA is present
in affected as well as unaffected skin. DH is a hereditary autoimmune
gluten intolerance disease linked with celiac disease. If you have
DH, you always have gluten intolerance. With DH, the primary lesion
is on the skin, whereas with celiac disease the lesions are in the
small intestine. The degree of damage to the small intestine is
often less severe or more patchy than those with celiac disease.
Both diseases are permanent and symptoms/damage will occur after
consuming gluten.
Symptoms
The lgA deposits under the skin result in eruptions of red raised
patches of skin, similar to the beginning of a pimple, that can
develop into small watery blisters. The itching and burning of the
eruptions are severe and the urge to scratch them is intense. Scratching
will further irritate the eruptions. Eruptions commonly occur on
pressure points, such as around the elbows, the front of the knees,
the buttocks, back face, and scalp but can appear anywhere on the
body. Eruptions are usually bilateral - occurring on both sides
of the body. 60% of those diagnosed are men and the most common
age at diagnosis is 15 to 40 years old. Although it is uncommon
to diagnose young children with DH, we are seeing more cases of
early childhood DH.
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Diagnosis
Your dermatologist will take a small biopsy of the unaffected
skin very close to an eruption or eruption site. The presence of
IgA deposits confirms a diagnosis of DH. Sometimes the dermatologist
may also want you to have blood work for celiac disease and see
a gastroenterologist.
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Treatment
Just as with celiac disease, strictly following a gluten-free
diet for life is the only complete treatment. It may take two or
more years on a gluten-free diet for the lgA deposits under the
skin to clear. Your doctors may prescribe medications for immediate
relief from the itching and burning eruptions. The most common medication
used is Dapsone. This medication has serious side effects and requires
regular monitoring by your physician. When taken to relieve the
symptoms of DH, Dapsone should be taken in the smallest effective
doses for as short a time as possible. Medications for DH should
not be used during pregnancy.
If you use medications to relieve the itching caused from DH, but
do not follow a gluten-free diet, you run the risk of also developing
the intestinal problem - celiac disease and other complications.
Questions to Ask Your Doctor:
- Should I take medication for this disease?
- How long will I need to take this medicine and how will I know
when to stop taking it?
- What are the side effects of the medicine?
- How often do I need to get my blood drawn to monitor this medicine's
effect on my body?
- What else can trigger DH?
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Prognosis
Excellent, if you stay on the gluten-free diet. The severity and
frequency of eruptions will decrease as you continue with the diet.
Iodine can trigger eruptions in some people. However, iodine is
an essential nutrient and should not be removed from the diet without
a physician's supervision.
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Related Disorders
Thyroid disease is most commonly associated with DH. Other autoimmune
disorders that people with CD are at greater risk to develop include
Addison' s disease, autoimmune chronic active hepatitis, Alopecia
Areata, Graves' disease, insulin-dependent diabetes mellitus (type
1), myasthenia gravis, scleroderma, Sjogren's syndrome, systemic
lupus erythematosus, and thyroid disease. This is not a complete
list. Thyroid diseases and diabetes are the two most commonly associated
diseases. It is not uncommon to have other skin conditions as well.
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Education
Download the following publications from our site for free. All
documents are in PDF file format. You may click
here to download free Acrobat Reader software.
Dermatitis
Herpetiformis
Associated
Autoimmune Diseases
Quick
Start Diet Guide
Adding
Fiber to Your Gluten-Free Diet
Also see our Marketplace section for links to books and cookbooks
available on Amazon.com
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Gluten
Intolerance Group®