What Dermatitis Herpetiformis Looks Like

A Chronic Rash Associated with Celiac Disease

Dermatitis herpetiformis is an intensely itchy, blistering rash that affects some people with celiac disease.

Celiac is a condition in which gluten, a protein found in some grains, triggers an autoimmune response. With autoimmune conditions, the body mistakenly attacks itself. In this case, the small intestine is the target. When dermatitis herpetiformis also occurs, the skin is being attacked as well.

It is easy to mistake dermatitis herpetiformis for other skin conditions. That is why you need to undergo testing by a specialist to confirm the diagnosis and start the appropriate treatment.

This gallery of images can help you identify the signs and symptoms of dermatitis herpetiformis. It also outlines the steps a healthcare provider will take to formally diagnose you and how the condition can be treated.

Also Known As

Dermatitis herpetiformis is sometimes called:

  • Celiac disease rash
  • Gluten rash

Dermatitis Herpetiformis Symptoms

Dermatitis herpetiformis rash

Dermnet/Creative Commons

Although dermatitis herpetiformis can form anywhere on your body, it is most frequently seen on extensor surfaces (areas of skin on the outside of a joint) such as the elbows, knees, buttocks, ankles, groin, lower back, and back of the neck.

The rash can be intensely itching and is often accompanied by a burning sensation.

The rash has distinctive reddish-purple, fluid-filled bumps, as seen here. The blisters can be as small as a pinhead or as large as a quarter-inch in size.

A dermatitis herpetiformis rash tends to come and go. During outbreaks, a person may be unable to resist scratching, which can leave behind purplish marks on the skin that can last for weeks or months.

It usually takes several days for the rash to heal, during which new bumps often develop nearby.

People with severe dermatitis herpetiformis often have continuously reddened, speckled skin where scar tissue has developed.

Recap

Dermatitis herpetiformis can cause an intensely itchy, burning rash with fluid-filled bumps. The rash mainly affects areas of skin on the outside of a joint such as the knees or elbows.

Severe Dermatitis Herpetiformis

Dermatitis herpetiformis rash on child

Centers for Disease Control and Prevention

This photo shows a severe case of dermatitis herpetiformis in a 4-year-old child.

The rash most often develops between the ages of 30 and 40, but people of any age can be affected. Dermatitis herpetiformis had long been thought to be rare in children under 10, but more cases are being identified by researchers.

Most cases are chronic, with the frequency of outbreaks varying from one person to the next. In the majority of cases, the outbreaks will occur on the same part of the body every time.

Recap

Dermatitis herpetiformis typically starts between the ages of 30 and 40, although all ages can be affected. The condition can come and go with outbreaks generally affecting the same part of the body again and again.

Dermatitis Herpetiformis on the Lower Limbs

Dermatitis herpetiformis rash on feet

BallenaBlanca / Creative Commons

Because of its appearance and itchiness, the rash is often mistaken for other skin conditions, including allergic dermatitis, contact dermatitis, eczema, psoriasis, scabies, and shingles.

What differentiates dermatitis herpetiformis from these other skin conditions is that it is most often symmetrical, meaning it affects both sides of the body at the same time.

Associated Skin Conditions

Dermatitis herpetiformis isn't the only skin condition linked to celiac disease. Eczema—an itchy, scaly rash that's common in children but also seen in adults—may be associated with both celiac disease and non-celiac gluten sensitivity.

Psoriasis—an autoimmune skin condition that leads to thick, red, scaly plaques—also shares a strong link with celiac and gluten sensitivity.

However, dermatitis herpetiformis has the strongest link with celiac disease of any skin condition. All told, between 15% to 25% of people with celiac disease also have dermatitis herpetiformis.

If you've been diagnosed with dermatitis herpetiformis, you almost certainly have celiac disease. 

Recap

Dermatitis herpetiformis is often mistaken for other skin conditions like eczema, psoriasis, scabies, shingles, and allergic or contact dermatitis. What differentiates dermatitis herpetiformis is that it tends to affect both sides of the body at the same time.

Dermatitis Herpetiformis on the Abdomen

Dermatitis herpetiformis rash on abdomen

Dermnet / Creative Commons

This photo shows a dermatitis herpetiformis outbreak on the abdomen. Note the symmetrical presentation of the rash.

Diagnosis

Dermatitis herpetiformis is diagnosed with a combination of a blood test and skin biopsy.

The blood test looks for immune proteins, called immunoglobulin A (IgA) antibodies, that are associated with dermatitis herpetiformis.

With a biopsy, a small sample of skin is removed in a practitioner's office. If you have dermatitis herpetiformis, the sample will show deposits of IgA in the area between the top and middle layers of skin when examined under a microscope.

In some cases, the doctor may order a biopsy of the small intestine to confirm if celiac disease is involved. This is performed in people who are not on a gluten-free diet as the diet can lead to a false-negative result.

Recap

Dermatitis herpetiformis is diagnosed with a combination of a blood test and skin biopsy, both of which check for the presence of antibodies associated with this autoimmune skin condition.

Dermatitis Herpetiformis on the Hands

Dermatitis herpetiformis rash on hands

BallenaBlanca / Creative Commons

It's somewhat unusual to see dermatitis herpetiformis on the hands, but the rash can ultimately occur anywhere on the body.

Dermatitis herpetiformis appears to be more common in men, unlike celiac disease which is diagnosed more often in women. In fact, some studies suggest that males are twice as likely to have dermatitis herpetiformis than females.

There's been relatively little research done on the health risks associated with dermatitis herpetiformis. Some studies show an increased risk of thinning bones comparable to that seen in people with celiac disease.

Other studies have reported an increased risk for thyroid disease—not surprising, since celiac disease and thyroid disease are often diagnosed together.

Treatment

Currently, the only long-term treatment for dermatitis herpetiformis is a gluten-free diet. 

The oral antibiotic dapsone may provide short-term relief but can cause significant side effects in some people, including nausea, vomiting, dizziness, blurred vision, insomnia, ringing in the ears, and anemia.

For this reason, dapsone is used sparingly to help bring the rash under a control.

Recap

Dermatitis herpetiformis is more common in males than females. The only effective, long-term treatment is a gluten-free diet, although the oral antibiotic dapsone may be used to help bring the rash under control.

Celiac Disease Doctor Discussion Guide

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Summary

Dermatitis herpetiformis is an autoimmune skin condition linked to celiac disease that causes an intensely itchy rash with tiny fluid-filled blisters. Between 15% and 25% of people with celiac disease have dermatitis herpetiformis.

The rash usually affects areas of skin on the outside of a joint (such as the knee or elbow) on both sides of the body at once. The condition can come or go but tends to affect the same body part each time. Severe cases can cause scarring and ongoing redness.

The most effective treatment for dermatitis herpetiformis is a gluten-free diet, although the oral antibiotic dapsone may help resolve the rash and relieve itching and discomfort.

A Word From Verywell

Controlling your dermatitis herpetiformis with a gluten-free diet can be difficult. Some studies suggest that you need to be even stricter if you have dermatitis herpetiformis than you do if you have celiac disease alone.

Even so, the benefits tend to be worth it. If you can get the rash into remission, any future outbreaks should be less severe and/or frequent. A certified dietitian can teach you how to be gluten-free and help you identify hidden gluten in foods.

Frequently Asked Questions

  • Can I get a gluten rash if I don’t have celiac disease?

    Yes. If you’re allergic to gluten (which is different than having celiac disease), you can develop an allergic rash.

  • How quickly does a gluten rash develop?

    Outbreaks can occur within hours or days of eating gluten if you have celiac disease. If you have a wheat allergy, a rash might begin within two hours, although the cause will be allergic rather than autoimmune.

  • Can celiac disease affect your eyes?

    In rare cases, celiac disease can cause cataracts (clouding of the lens), although the reasons are not entirely clear. It may be due to the excessive absorption of vitamin A, vitamin D, and calcium or because autoimmune antibodies are directly attacking the eye.

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14 Sources
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