GIG: Understanding Dermatitis Herpetiformis

From the Gluten Intolerance Group of North America:

Dermatitis Herpetiformis (DH) is a chronic disease of the skin marked by groups of watery, itchy blisters.

The ingestion of gluten (a protein contained in wheat, rye and barley) triggers an immune system response that deposits lgA antibodies under the top layer of skin. IgA antibodies are present in affected as well as unaffected skin.

DH is a hereditary autoimmune disease linked with gluten intolerance. If you have DH and do not follow a gluten-free diet, you may develop the intestinal damage of celiac disease.

With DH, the primary lesion is on the skin rather than the small intestine. The degree of damage to the small intestine is often less severe or more patchy than for those with only celiac disease. Both diseases are permanent and symptoms/damage will occur after consuming gluten.

Symptoms of Dermatitis Herpetiformis

The lgA deposits result in eruptions of a painfully itchy rash and may progress to red, raised patches of skin (similar to the beginning of a pimple) that 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 - around the elbows, the front of the knees, the buttocks, back, shoulders, face, and scalp, but can occur anywhere. Eruptions are usually bilateral, occurring on both sides of the body. Sixty percent of those diagnosed are men and the most common ages at diagnosis are between 15 and 40 years old.

Diagnosis of Dermatitis Herpetiformis

If the eruptions appear to be DH, your dermatologist will take a small biopsy of unaffected skin, next to an eruption. The presence of IgA deposits confirms a
diagnosis of DH.

Treatment of Dermatitis Herpetiformis

Strictly following a gluten-free diet for life is the only complete treatment. This involves the elimination of wheat, rye, barley, and foods made from these grains from your diet. It may take two or more years for the lgA deposits under the skin to completely clear.

(Worth noting: A medication called Dapsone may also be prescribed. You will need to follow up with your doctor on a regular basis if you use this drug. Dapsone allows the eruptions to heal, but does not cure DH. Discuss the potential side effects of this drug with your doctor before starting it. Your goal should be to take as little as possible for as short a time as required to allow the diet to control the DH.)

If you have questions about Dermatitis Herpetiformis, please email the IBS Treatment Center and Center for Food Allergies at info@ibstreatmentcenter.com.

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