Learn About Dermatitis Herpetiformis and Celiac Disease

If you've been officially diagnosed with dermatitis herpetiformis, you almost certainly do have celiac disease as well. However, the whole issue can be confusing, and some explanation is in order. 

Dermatitis Herpetiformis skin rash on a leg

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The Gluten Rash

The "gluten rash" dermatitis herpetiformis (yes, it's a mouthful) is an incredibly itchy, painful rash that results from your body's reaction to the consumption of gluten, a protein found in wheat, barley, and rye. Although you can experience the rash anywhere on your body, it most commonly crops up on places like your elbows, knees, buttocks, lower back and the back of your neck.

It's remarkably uncomfortable to have, to put it mildly. When you consume gluten, your rash, which will include red bumps and blisters filled with a watery substance, likely will appear in the same place every time. The only way to force it into abeyance is to cut gluten from your diet completely.

How Dermatitis Herpetiformis Relates to Celiac Disease

Some physicians consider them two aspects of the same condition, with the dermatitis herpetiformis rash classed as a symptom of celiac disease. Other physicians, meanwhile, consider celiac disease and dermatitis herpetiformis to be closely related, but not exactly the same condition. In recent years, however, a consensus has been forming around the "two aspects of the same condition" viewpoint.

The vast majority of physicians will look at it this way: If you have a diagnosis for dermatitis herpetiformis and your celiac antibody blood tests also came back positive, you have celiac disease. If, however, your blood tests for celiac disease came back negative, your dermatologist may refer you to a gastroenterologist for an intestinal biopsy, considered the gold standard for celiac disease diagnosis.

Starting the gluten-free diet (followed super-strictly) should halt both your celiac disease symptoms and your dermatitis herpetiformis symptoms in their tracks.

Celiac Disease, Dermatitis Herpetiformis Both Autoimmune

Both celiac disease and the dermatitis herpetiformis rash are considered autoimmune diseases, where your body's immune system mistakenly attacks your own cells instead of foreign invaders. In celiac disease, your body's immune system erroneously attacks the villi in your small intestines, causing damage that leads to difficulties absorbing needed nutrients.

Meanwhile, in dermatitis herpetiformis, the immune system attacks your skin instead of (or more realistically, in addition to) your intestinal villi. Dermatitis herpetiformis causes long-lasting purplish marks, and scarring is possible, especially if you can't resist the urge to scratch your rash (and you most likely can't, because it's the itchiest rash imaginable).

Dermatitis herpetiformis affects between 15 and 25 percent of people with celiac disease, mainly adults, and many of these people have no gastrointestinal symptoms. Although the medication dapsone can help to clear up your rash, you'll need to stay on the gluten-free diet long term to prevent celiac disease complications.

2 Sources
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  1. Celiac Disease Foundation. Dermatitis Herpetiformis.

  2. National Institute of Diabetes and Digestive and Kidney Diseases. Dermatitis Herpetiformis.

By Jane Anderson
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.