Last reviewed by Editorial Team on August 13th, 2018.
What is Dermatitis Herpetiformis?
This medical condition is a chronic skin condition and appears most often in people who have gluten sensitivities like people who have Celiac Disease. It can appear on any area of your body including your neck, legs, and arms but is most prominently found on your knees, back, scalp, and elbows. You will rarely get it on your face. By being “chronic” which means that this skin condition will continue for a long period of time.
Dermatitis herpetiformis will usually occur in people between the ages of twenty and forty but it can also affect the elderly and children. Many times once you have an outbreak it can appear again.
Symptoms of Dermatitis Herpetiformis
The symptoms can come and go and can include:
- Bumps or blisters that are extremely itchy that appear in a cluster and are pink or white in appearance with the skin around it being flushed red. They are usually filled with fluid.
- The rash is the same shape and size on both sides
- You may mistake the rash for eczema
- Some people could have scratch marks instead of the blisters
- Having a burning feeling in the blisters that appear on the body and you should not scratch them because it can make them burst.
- Possible weight loss.
When a person has dermatitis herpetiformis they will have the intense burning and itching sensation along with the rash before the blisters or bumps appear. After the blisters or bumps develop crusts they will tend to lose their itching sensations.
The exact cause is not known but dermatitis herpetiformis is thought to be linked with gluten consumption. Gluten is a composite that is formed from several different proteins and most commonly found in wheat and other grains like rye and barley. Gluten is what adds the characteristic chewiness and texture to baked goods. When a person has a case of dermatitis herpetiformis it can be a key indicator of having gluten sensitivity. It can also be a red flag if it happens to patients for the first time and has no known previous sensitivity to gluten.
According to researchers they think that the skin condition happens when the gluten that is in your intestinal tract binds to certain antibiotics and then begins to circulate in your bloodstream. When the gluten reaches the surface of your skin an immune reaction happens. This immune reaction is what causes the burning, and itching and eventually the blisters on your skin. Because of this it makes dermatitis herpetiformis a form of autoimmune disease because it is caused by your body’s attack on itself.
It has also been reported to happen in people who have vitiligo, rheumatoid arthritis, type 1 diabetes, and autoimmune thyroid disorder.
In order to diagnosis this chronic skin condition in most cases the physician will have a direct immunofluorescence test of the skin and a skin biopsy done. The physician may also recommend a biopsy of your intestines to confirm the diagnosis. Blood tests also will help with the diagnosis.
Because it is thought that dermatitis herpetiformis is linked to gluten consumption the obvious treatment would center primarily on making sure that you are eating a diet that is gluten-free. During the initial stage of treatment the physician may use prescription medications. One medication that may prescribe is Dapsone, an antibacterial medication, to help control the outbreaks of dermatitis herpetiformis and will help to control the blisters and rash. It has anti-inflammatory properties and combined with the antibacterial properties it can also help stop the itching. Some of the other forms of treating dermatitis herpetiformis can include:
- Taking warm or cool baths to ease the uncomfortable sensations that is associated with this chronic skin condition.
- Having ultraviolet light therapy can help to alleviate some of the symptoms.
- Diaminodiphenyl sulfone – this is a specific antibiotic that is sometimes used to treat this chronic skin condition. This antibiotic is normally prescribed after the condition is diagnosed and will often be discontinued after you are able to adjust to a diet that is gluten-free. If the symptoms come back you may have to take more treatments with this antibiotic.
- Ibuprofen – this is usually the over-the-counter medication that is recommended to give you relief from pain. Although this is a NSAID it appears that it is the only one in this category of medication that does not make the symptoms worse. Taking any other NSAIDs can make dermatitis herpetiformis worse.
- Acetaminophen – this is another over-the-counter pain relief that you can take. This includes Tylenol
- Aloe Vera – apply fresh aloe Vera gel over the blisters to help reduce the irritation and itching.
When going on a gluten-free diet you will have to shop very carefully and learn how to read food labels very closely to see if the food item contains gluten. What makes it so hard to follow a gluten-free diet is that on some food labels gluten may not be listed specifically. Some of the different products that do contain gluten are oats, rye, and wheat. It is also present in hydrolyzed vegetable proteins, preservatives, malts, and artificial colors. If you are told to follow a gluten-free diet you will have to follow it for life to make sure that the symptoms of dermatitis herpetiformis does not return. You should also avoid dairy products because they can sometimes cause a skin rash and it is also one of the triggers of dermatitis herpetiformis. One important point is that not everyone who has gluten sensitivities will get this chronic skin condition.