What is Dermatitis Herpetiformis?
Dermatitis Herpetiformis is a rather annoying and quite a difficult problem which consists of itchy, blistering, and burning skin rashes. These skin rashes usually develop on the elbows, scalp, back and the buttocks. The main reason behind this rash is said to be intolerance to gluten. Intolerance to gluten may arise from a much serious medical condition called as celiac disease. Dermatitis Herpetiformis is also known by the name of Gluten Rash. Individuals with a known diagnosis of Dermatitis Herpetiformis are recommended to eat a gluten free diet.
Dermatitis Herpetiformis does not affect any particular individual and is usually seen in people who already have a family member with this condition. Even though celiac disease is more found in females, it is the males who get Dermatitis Herpetiformis more than females. The rash starts to develop when the individual is in his mid 20s although there have been cases where this rash develops in childhood itself. People of European descent are more likely to develop Dermatitis Herpetiformis that other population.
What Causes Dermatitis Herpetiformis?
The main cause of Dermatitis Herpetiformis as stated above is gluten intolerance which arises from celiac disease. Hence it can be said that an individual with celiac disease is more than likely to develop Dermatitis Herpetiformis. Celiac Disease is an autoimmune disorder that arises due to intolerance to gluten. Gluten is found in abundance in foods wheat, rye, and barley. Some types of oats also have glutenin them. Studies suggest that about 30% of people with celiac disease go on to develop Dermatitis Herpetiformis, although individuals with Dermatitis Herpetiformis do not tend to have other common symptoms of celiac disease like gastrointestinal symptoms of diarrhea, constipation, abdominal cramping and the like but if an individual has intolerance to gluten and has known Dermatitis Herpetiformis but continues to east gluten then there may be severe intestinal damage done.
The rash of Dermatitis Herpetiformis are formed due to an interaction between the gluten proteins and IgA which is a type of an antibody which is formed by the immune system to attack gluten and in the process of eliminating gluten from the body these symptoms develop. When IgA attaches to gluten to destroy them it enters the bloodstream and obstruct the tiny blood vessels especially in the skin which attracts the white blood cells and these white blood cells release a chemical which results in the development of the itchy red skin rash.
What are the Symptoms of Dermatitis Herpetiformis?
The classic presenting feature of Dermatitis Herpetiformis is the presence of a skin rash in the elbows, knees, lower back, back of the neck, shoulders, buttocks, and scalp. The rash comes and goes spontaneously and is mostly of the same size. Prior to the development of the rash, the skin over the area may burn or itch for some time and initially the rash may resemble a pimple. These rashes stay for some days and then go on to heal but only to recur once again.
How is Dermatitis Herpetiformis Diagnosed?
The best way to diagnose Dermatitis Herpetiformis is to do a skin biopsy. If an individual has recurrence of rashes on the areas mentioned above that come and go then a visit to a physician is required. The physician will first rule out other medical conditions like atopic dermatitis and the like and once those conditions have been ruled out then a skin biopsy will be done in which a small sample of skin will be taken and analyzed. This will reveal the clogs formed by the attachment of gluten to IgA and confirm the diagnosis of Dermatitis Herpetiformis. Immunofluorescence test is yet another way to confirmatively diagnose Dermatitis Herpetiformis. In this test, a stain is applied around the site of the rash and it will clearly show the presence of IgA antibodies confirming the diagnosis of Dermatitis Herpetiformis.
How is Dermatitis Herpetiformis Treated?
The most preferred way to treat Dermatitis Herpetiformis is with an antibiotic called dapsone. This is quite a powerful medication and has a significant side effect profile and hence physicians prefer to go slow with this medication and taper up the dose gradually over a period of several months before it is fully effective. Some of the side effects of dapsone are:
Some of the other medications that have shown some effectiveness in treating Dermatitis Herpetiformis are tetracycline, sulfapyridine, and certain immunosuppressants.
Even though medication may help an individual with Dermatitis Herpetiformis to a significant degree but the best possible way to get rid of Dermatitis Herpetiformis and to prevent them from recurring is to adhere to a strict gluten free diet. A gluten free diet means that an individual should avoid eating the following:
What is the Prognosis of Dermatitis Herpetiformis?
Dermatitis Herpetiformis is a condition which persists throughout the life. The rashes may go into remission for a while but they will again recur to trouble the individual and hence it is extremely vital to get a confirmed diagnosis of both Dermatitis Herpetiformis and celiac disease and adhere to a strict gluten free diet along with taking medications as prescribed by the physician to keep the symptoms under control of Dermatitis Herpetiformis.
- Celiac Disease Foundation. “Dermatitis Herpetiformis.” https://celiac.org/about-celiac-disease/related-conditions/dermatitis-herpetiformis/
- National Organization for Rare Disorders (NORD). “Dermatitis Herpetiformis.” https://rarediseases.org/rare-diseases/dermatitis-herpetiformis/