What Is Dermatitis Herpetiformis? (A Guide) 

Updated on July 1st, 2019

What's In This Guide?

    Disclaimer: Before You Read

    It is important to know that your genes are not your destiny. There are various environmental and genetic factors working together to shape you. No matter your genetic makeup, maintain ideal blood pressure and glucose levels, avoid harmful alcohol intake, exercise regularly, get regular sleep. And for goodness sake, don't smoke.

    Genetics is a quickly changing topic. Read More.

    Dr. Louis Duhring, the first American dermatologist to discover a skin disease, described dermatitis herpetiformis in 1884. Today modern scientific research has considerably advanced our understanding.

    It’s called “herpetiformis” even though it’s not a herpes virus for a good reason. If you see dermatitis herpetiformis pictures, you’ll notice that the puffy red bumps and itchy blisters resemble herpes lesions.

    This skin condition is rare and some other names for it include DH, Duhring’s disease, Duhring-Brocq disease, Brocq-Duhring disease, or dermatitis multiformis 1.

    Here at YourDNA, we want you to have accurate information about rare diseases so you can make clear medical decisions. In this article, we will share the latest available scientific findings on dermatitis herpetiformis.

    What Is Dermatitis Herpetiformis (DH)?  

    Medical scientists link dermatitis herpetiformis with celiac disease, viewing DH as a cutaneous manifestation of it 2.

    Celiac disease is an autoimmune disease caused by a sensitivity to gluten, a protein found in grains, especially wheat.

    DH is a chronic skin condition, a fiercely itchy rash characterized by bumps and blisters.

    Dermatitis Herpetiformis and Genetics 

    Those who have dermatitis herpetiformis have a genetic predisposition to get it, but environmental issues also play a huge role.

    What Is the Connection Between Dermatitis Herpetiformis and Celiac Disease? 

    Does dermatitis herpetiformis always mean celiac disease is also present? No. However, they are both triggered by an autoimmune response to gluten. So, many people who have dermatitis herpetiformis also have celiac disease.

    While dermatitis herpetiformis manifests as an extreme skin reaction after consuming gluten-rich foods rich, celiac disease is a gluten-sensitive enteropathy.

    Frequently Asked Questions

    Here are some answers to frequently asked questions about dermatitis herpetiformis:

    Q: Is dermatitis herpetiformis contagious?

    A: No because there is a genetic component to this disease.

    Q: Are there any essential oils for gluten rash?

    A: There are no essential oils for gluten rash.

    Q: Does Benadryl help dermatitis herpetiformis?

    A: Some people have reported relief.

    Q: What is the best dermatitis herpetiformis diet?

    A: Dermatitis herpetiformis foods to avoid are foods with grains or iodine so a gluten-free diet is the best one.

    Q: Does dairy cause a DH rash?

    A: Dermatitis herpetiformis dairy rashes are actually due to the presence of iodine in dairy products.  

    Q: What does gluten do to a celiac disease patient?

    A: It damages the small intestines and reduces nutrient absorption.

    Q: Can you get scars from dermatitis herpetiformis?

    A: A medication like dapsone can provide quick healing with little scarring.

    Q: Where to biopsy for dermatitis herpetiformis?

    A: You should see a dermatitis herpetiformis specialist.

    Causes of Dermatitis Herpetiformis 

    Although scientists don’t know the exact cause of dermatitis herpetiformis, they understand the biological mechanisms of the dermatitis herpetiformis pathology that creates the rash.

    Someone with celiac disease who eats gluten will quickly experience intestinal inflammation. Their intestines will manufacture an antibody to combat the perceived threat of a gluten invasion.

    Once released into the bloodstream, antibodies like IgA flow to the skin and build blood vessels. As these chemicals lodge inside the skin and cause a rash.

    Patients experience this skin rash as intense itching and it appears as reddish bumps and sensitive blisters.

    The rash does not appear all over the body. Instead, it occurs in specific areas like the scalp, back, shoulder blades, buttocks, elbows, and knees. While these are the most frequent areas, there are other areas that could be affected. Dermatitis herpetiformis scalp appears in the scalp and dermatitis herpetiformis face shows up in the face.

    What Triggers Dermatitis Herpetiformis? 

    When someone with celiac disease ingests gluten, it triggers an immune response that creates antibody deposits under the skin and causes dermatitis herpetiformis.

    Diseases Associated With Dermatitis Herpetiformis 

    One study found many endocrine diseases associated with dermatitis herpetiformis 3:

    • Autoimmune thyroid disease
    • Insulin-dependent diabetes
    • Lupus erythematosus
    • Sjogren’s syndrome
    • Sarcoidosis

    Can You Have Dermatitis Herpetiformis Without Having Celiac Disease? 

    It is possible to have dermatitis herpetiformis without celiac disease–but about 25% of those with celiac reactions also have dermatitis herpetiformis 4.

    Celiac disease is an autoimmune disorder — the immune system overreacts to gluten ingestion by creating and mobilizing antibodies to ward off the perceived threat.

    IgA is just one of many antibodies that might be involved. Dermatitis herpetiformis tTG type and the dermatitis herpetiformis IgE type are other types of autoantigens that could be produced.

    Can Dermatitis Herpetiformis Be Prevented?

    While medications can help improve the symptoms and sticking to a completely gluten-free diet can prevent complications, modern medicine can’t prevent DH.

    Dermatitis Herpetiformis Symptoms

    Someone with dermatitis herpetiformis will feel burning and stinging sensations on their skin. The appearance of DH may also be an early warning sign of celiac disease.

    A DH rash often occurs around the elbows, knees, scalp, buttocks, back, and shoulders. However, it might also erupt around face, neck, and groin.

    Symptoms could appear as a cluster of red bumps. They might appear as fluid-filled blisters or as different types of sores — hive-like sores, fluid-filled sores, or raised sores.

    Dermatologists could mistake these bumps for eczema, asking you to wait for a week or two to see if they heal. Unfortunately, while they do heal within this period, it’s not for long.

    New bumps and blisters show up. Then as they scab over and heal, symptoms go into remission — only to flare up once again. This cycle of appearing and disappearing symptoms is perpetual.

    What Does a Gluten Rash Look Like?

    A dermatitis herpetiformis skin rash has some distinctive characteristics, making it easy to distinguish it from other kinds of rashes.

    These are often blistering, itchy rashes. Sufferers often describe them as intensely burning rashes.

    Although appearing in different locations of the body, they often concentrate around back, buttocks, scalp, knees, and elbows.

    Usually, the rashes occur after consuming food with gluten.

    Dermatitis Herpetiformis Risk Factors 

    Who Gets Dermatitis Herpetiformis?

    People who get DH show some damage to their small intestine and about 25% of sufferers also have celiac disease.

    It rarely shows up in children or even young adults, and most often occurs to those between 30 and 40 years of age.

    Men are more likely to get it than women.

    Ethnically, it occurs in people of northern European descent, and it’s rare to find it in people of African or Asian descent.

    Diagnosis of Dermatitis Herpetiformis 

    Although it’s possible to discern dermatitis herpetiformis by its unusual appearance, it’s also possible to misdiagnose it. When a patient comes in with a mild gluten rash, a doctor may puzzle over dermatitis herpetiformis vs eczema symptoms.

    So, since the observation of symptoms alone is not enough, doctors rely on a skin biopsy to determine dermatitis herpetiformis.

    First, a doctor numbs out a certain area, then he or she uses a small instrument to punch out a part of the skin. After the doctor stitches up the wound, it typically heals quickly, with little scarring.

    In the lab, medical techs dye the sample to detect antibodies like IgA. These antibodies occur in a recognizable pattern.

    Since dermatitis herpetiformis correlates closely with celiac disease, a doctor may also do a blood test for celiac disease.

    Genetic Testing for Dermatitis Herpetiformis 

    Although it is possible to inherit dermatitis herpetiformis, environmental factors play such an important role that genetic testing alone is insufficient.

    Testing with a skin biopsy and an immunofluorescence microscopy skin test is more conclusive. A blood test will also determine if the patient has celiac disease.  

    Dermatitis Herpetiformis Treatment Options 

    The most effective treatment of dermatitis herpetiformis is medication.

    An oral medication like dapsone can heal a rash. It can get rid of itching and bumps and blisters, in one to three days. Sometimes, if the itching is severe, a doctor may also recommend a topical corticosteroid cream for faster relief.

    Dapsone is the best medication currently available. Other solutions like dermatitis herpetiformis treatment prednisone are less effective.

    If someone can’t get medical help, they might get temporary relief from a dermatitis herpetiformis over-the-counter treatment. Home remedies may sometimes also work.

    Home remedies for gluten rash include the dermatitis herpetiformis apple cider vinegar cure. This works in some people because it detoxifies the body, reducing the amount of gluten in the system.

    Besides medication to help with the rash, a doctor may also test for celiac disease. Treating celiac disease mitigates dermatitis herpetiformis symptoms.

    Dietary changes are also necessary to reduce the frequency and intensity of skin rashes. A patient should eat a gluten-free diet 5, as well as avoid iodine because it aggravates dermatitis herpetiformis.

    Medication and dietary changes won’t cure dermatitis herpetiformis, but they make it more manageable, providing necessary relief from outbreaks.

    How Long Does It Take for Dermatitis Herpetiformis to Clear Up?

    The symptoms of dermatitis herpetiformis can take one to two weeks to clear. Once blisters scab over and heal, new blisters will soon grow again. Symptoms clear but then show up again.

    Bumps and blisters heal only to flare up again. Once someone has dermatitis herpetiformis, it does not go away.

    Possible Complications of Dermatitis Herpetiformis

    Many complications can arise from dermatitis herpetiformis, such as autoimmune thyroid disease and cancers. The most typical type of cancers are lymphomas of the intestines.

    Other complications can arise as side-effects of the drugs used for treating dermatitis herpetiformis.

    However, despite side effects, treatment is essential. With treatment, the disease can be well-controlled. Without it, a patient not only suffers the symptoms of dermatitis herpetiformis but is also at risk for associated diseases like intestinal cancer.    

    Conclusions

    Dermatitis herpetiformis is a chronic disease characterized by a skin rash. The rash is itchy and manifests as bumps, sores, and blisters.

    The disease is rare, with less than 200,000 cases in the United States each year.

    Although medical professionals can’t cure it, they can provide effective treatment for temporary relief. The dermatitis herpetiformis treatment dapsone medication can provide relief in 24 to 48 hours.

    Since DH is one of those diseases that requires a gluten-free diet, patients usually receive an information sheet on how to follow this type of diet.

    Medical diagnosis comprises of lab testing a tissue sample and imaging.

    Researchers do not know the exact cause of the dermatitis herpetiformis dermatology that causes gluten rash or scabies. All they know is that the disease is a combination of genetics and environmental factors like gluten sensitivity.  

    Gluten triggers an autoimmune disorder when someone ingests it. The immune system responds by attacking healthy cells to ward off the threat. The primary symptom is a skin rash that heals but returns.  

    Referenced Sources

    1. Dermatitis Herpetiformis.
      NORD (National Organization for Rare Disorders). NORD. 2015.
    2. The Diagnosis and Treatment of Dermatitis Herpetiformis.
      Antiga, Emiliano, and Marzia Caproni. 2015.
    3. Diseases Associated with Dermatitis Herpetiformis.
      Reunala, T, and P Collin. 1997.
    4. Dermatitis herpetiformis.
      Berman K, Zieve D. May 15, 2013.
    5. Dermititis Herpetiformia Treatment & Management.
      Miller JL. June 12, 2014.