Digestive Health Celiac Disease Symptoms Print What Dermatitis Herpetiformis Looks Like Does your rash look like these photos? Gluten may be causing it By Jane Anderson Updated July 08, 2019 Medically reviewed by Casey Gallagher, MD More in Celiac Disease Symptoms Nutrition Diagnosis Gluten Sensitivity Living With Related Conditions Dermatitis herpetiformis is an itchy, stinging, blistering skin rash that occurs in some people who also have celiac disease. In fact, some people call dermatitis herpetiformis the "gluten rash" or the "celiac disease rash." Gluten is a protein that occurs in the grains wheat, barley, and rye. When you have celiac disease, your body responds to ingestion of this protein by mistakenly attacking your small intestine. If you have dermatitis herpetiformis, your immune system attacks your skin as a result of gluten ingestion. Currently, the only long-term treatment for dermatitis herpetiformis is the gluten-free diet. The medication Dapsone can offer short-term relief for dermatitis herpetiformis sufferers, but Dapsone carries some significant risks, so doctors generally recommend you stay on it only for long enough to bring the rash under control and to learn to eat gluten-free. Unfortunately, it's easy to mistake dermatitis herpetiformis for other skin conditions. That's why you need accurate testing to determine if you have it or not. The following photos may help you determine whether to talk to your doctor about getting tested for dermatitis herpetiformis. 1 Does Your Rash Look Like This? Gluten May Be Causing It Dermnet/Creative Commons Although dermatitis herpetiformis can form anywhere on your body, its most frequent locations include the elbows, knees, buttocks, lower back and the back of the neck. In most cases (but not all), it's one of the itchiest skin conditions you can experience. This photo shows a close-up of the rash, with its distinctive tiny reddish-purple bumps. The dermatitis herpetiformis bumps usually take several days to heal (during which time new bumps usually appear nearby), and once healed, those bumps will leave behind small purple marks that last for weeks or months. People with long-standing dermatitis herpetiformis usually have continuously reddened, purple-dotted skin where their rash occurs. When dermatitis herpetiformis is severe, the lesions often are topped with clear, fluid-filled blisters that pop easily when scratched (and it's pretty difficult not to scratch this itchy rash). The liquid in those blisters contains white blood cells, which are drawn to the area as a result of the autoimmune attack on the skin. 2 Severe Dermatitis Herpetiformis on a Child's Buttocks Courtesy of Centers for Disease Control and Prevention This dermatitis herpetiformis photo shows a severe case of the rash in a 4-year-old child, according to the Centers for Disease Control and Prevention. The photo shows the fluid-filled blisters that often appear as part of the skin condition. Dermatitis herpetiformis had been thought to be rare in children younger than age 10, but newer research shows that it can occur in younger children. The rash often first surfaces in your teens, 20s or 30s, and it sometimes goes into remission even if you're eating a gluten-filled diet. The rash might be continuous, or it might come and go depending on your exposure to gluten (and possibly to other factors that haven't been isolated yet). Dermatitis herpetiformis sufferers usually experience their rashes in the same location every time. Before the actual dermatitis herpetiformis rash breaks out, your skin may itch in that location, or it might feel as if it's burning. The rash itself usually includes reddened skin plus multiple small, pimple-like bumps, which contain a clear liquid. 3 Dermatitis Herpetiformis on the Abdomen Dermnet/Creative Commons This photo shows dermatitis herpetiformis that appeared on the abdomen. In most cases, the rash will be symmetrical, so it occurs on both sides of your body at once. If you have it on one side of your abdomen, you'll usually have it on the other side too, as this person does. However, if your rash isn't symmetrical, it doesn't necessarily rule out dermatitis herpetiformis. Dermatitis herpetiformis is diagnosed through a skin biopsy procedure that looks for specific deposits of antibodies beneath the skin. A dermatologist usually performs the in-office procedure, which involves taking a small sample of skin. Experts advise finding a dermatologist who's knowledgeable about dermatitis herpetiformis to perform the biopsy since not all dermatologists are familiar with the condition or its diagnosis. It's important to sample the skin next to an active lesion, not directly on top of the lesion, or you risk missing the telltale antibodies. How to Find out for Sure If Your Itchy Rash Is Caused by Gluten 4 Dermatitis Herpetiformis on the Legs and Feet BallenaBlanca/Creative Commons Dermatitis herpetiformis frequently affects the knees and elbows—again, usually in a symmetrical fashion. In this photo, the rash appears below the knees on the legs and feet. The rash can be mistaken for several other conditions, including hives, acne, scabies, eczema and even bug bites or poison ivy (it's certainly as itchy as the itchiest of bug bites and poison ivy). This can be confusing because dermatitis herpetiformis isn't the only skin condition that's linked to celiac disease. Eczema—an itchy, scaly skin rash that's common in children but also occurs in adults—may be associated with celiac disease (and to non-celiac gluten sensitivity). And psoriasis—an autoimmune skin condition that leads to thick, red, scaly plaques on your skin that can be painful—also shares a strong link with celiac and gluten sensitivity. However, dermatitis herpetiformis has the strongest link with celiac disease of any skin condition: If you've been diagnosed with this skin condition, you almost certainly have celiac disease. About 15 percent to 25 percent of people with celiac disease also have dermatitis herpetiformis. Although many of those with dermatitis herpetiformis don't have obvious intestinal symptoms, 90 percent will have intestinal damage from gluten consumption. Unfortunately, some physicians aren't up on the latest research stating that dermatitis herpetiformis is the skin manifestation of celiac disease, and therefore requires a gluten-free diet. If yours isn't, you might want to consider getting a second opinion. Can My Itchy Gluten Rash Go Into Remission? 5 Dermatitis Herpetiformis on the Hands BallenaBlanca/Creative Commons It's somewhat unusual to see dermatitis herpetiformis on someone's hands, but the rash can occur anywhere on the body. Dermatitis herpetiformis may be more common in men (unlike celiac disease, which is diagnosed more often in women). In fact, some studies show a male-to-female ratio of up to two-to-one in dermatitis herpetiformis patients. There's been comparably little research done on the health risks associated with dermatitis herpetiformis, but one study does show a risk of thinning bones that's comparable with the risk faced by those with celiac disease. Another study found an increased risk for thyroid disease in those with dermatitis herpetiformis. This shouldn't be surprising since celiac disease and thyroid disease often are found together. A Word From Verywell Controlling your dermatitis herpetiformis through the gluten-free diet can be surprisingly difficult (you actually have to be significantly stricter to avoid skin symptoms than you do to avoid digestive symptoms from gluten). Anecdotally, those who have done it say it's worth it to eliminate the constant itching. If you can get your rash under control and into remission, any future outbreaks should be less severe (and eventually, not even particularly noticeable). Celiac Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Email Address Send There was an error. Please try again. This Doctor Discussion Guide has been sent to . Was this page helpful? Thanks for your feedback! Following a gluten-free diet can be challenging. We're here to help. Sign up and receive our free recipe guide for delicious gluten-free meals! Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Kárpáti S. Dermatitis herpetiformis. Clin Dermatol. 2012;30(1):56-9. doi:10.1016/j.clindermatol.2011.03.010 Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012;18(42):6036-59. doi:10.3748/wjg.v18.i42.6036 Antiga E, Caproni M. The diagnosis and treatment of dermatitis herpetiformis. Clin Cosmet Investig Dermatol. 2015;8:257-65. doi:10.2147/CCID.S69127 Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC. Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment. An Bras Dermatol. 2014;89(6):865-75. doi:10.1590/abd1806-4841.20142966 Paek SY, Steinberg SM, Katz SI. Remission in dermatitis herpetiformis: a cohort study. Arch Dermatol. 2011;147(3):301-5. doi:10.1001/archdermatol.2010.336 Dermatitis Herpetiformis. Celiac Disease Foundation. https://celiac.org/about-celiac-disease/related-conditions/dermatitis-herpetiformis/. Caproni M, Bonciolini V, D'errico A, Antiga E, Fabbri P. Celiac disease and dermatologic manifestations: many skin clue to unfold gluten-sensitive enteropathy. Gastroenterol Res Pract. 2012;2012:952753. doi:10.1155/2012/952753 Cooper BT, Holmes GK, Cooke WT. Coeliac disease and immunological disorders. Br Med J. 1978;1(6112):537-9. doi:10.1136/bmj.1.6112.537 Criado PR, Criado RF, Aoki V, et al. Dermatitis herpetiformis: relevance of the physical examination to diagnosis suspicion. Can Fam Physician. 2012;58(8):843-7. Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P. Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease. Nutrients. 2018;10(5) doi:10.3390/nu10050602 Lorinczy K, Juhász M, Csontos Á, et al. Does dermatitis herpetiformis result in bone loss as coeliac disease does? A cross sectional study. Rev Esp Enferm Dig. 2013;105(4):187-93. doi:10.4321/S1130-01082013000400002 Cunningham MJ, Zone JJ. Thyroid abnormalities in dermatitis herpetiformis. Prevalence of clinical thyroid disease and thyroid autoantibodies. Ann Intern Med. 1985;102(2):194-6. doi:10.7326/0003-4819-102-2-194 Additional Reading Dermatitis Herpetiformis. American Osteopathic College of Dermatology. J.A. Miller. Dermatitis Herpetiformis. eMedicine review.