Dermatitis herpetiformis (DH) is a bullous dermatosis characterized by the chronic recurrence of itching, erythematous papules, hives, edematous papules, and clustered vesicles that appear symmetrically on the extended surfaces, elbows, fronts of the knees, buttocks, the back and can also appear anywhere on the body. The disease is the cutaneous expression of gluten enteropathy similar to celiac disease. Ingestion of gluten triggers an immune system response that deposits a substance called IgA (immunoglobulin type A), on the top layer of the skin. IgA is present on both affected and unaffected skin. DH is an inherited autoimmune disease caused by gluten intolerance and is linked to celiac disease. If you have DH, then you are gluten intolerant. With DH, the primary lesion is in the skin, whereas in celiacs, the lesions are found in the small intestine. Those with DH often have less intestinal damage, and this damage is often more unevenly distributed than in celiacs.
IgA deposits on the skin result in pimple-like rashes that develop as small blisters. The burning and/or itching around these rashes is intense causing a burning desire to scratch. Scratching will, however, lead to irritation of the rashes. Note that rashes are usually bilateral, occurring on both sides of the body. Sixty percent of people with DH are male, and the age of diagnosis is between 15 and 40 years old. While it is unusual to diagnose this condition in young children,
Your dermatologist will take a skin sample during a biopsy, and this sample will be taken from unaffected skin very close to a rash or rash site. The presence of IgA deposits will confirm the diagnosis of DH. Sometimes the dermatologist will ask you to submit to a blood test for celiac disease and will refer you to a gastroenterologist.
As with celiac disease, the only treatment is a strict gluten-free diet for life. You have to be patient when you suffer from DH because the effects of the diet take time to show up, it can take two years and even more before the IgA deposits on the skin are eliminated. Your doctor may prescribe medication to relieve the burning and itching caused by the rashes. The most widely used drug is Dapsone. However, this drug has serious side effects and requires the supervision of your doctor. When this medication is taken to relieve symptoms of DH, it should be taken in the smallest effective amount possible and for the shortest period of time possible. Medications to relieve DH should not be taken during pregnancy.
If you take medication to relieve the itch caused by DH, but do not follow a gluten-free diet, you run the risk of also developing intestinal problems, celiac disease and other complications.
Questions to ask your doctor:
- Should I take medicine for this disease?
- How long will I need to take this medicine and how will I know to stop taking it?
- What are the side effects of this medication?
- How often should I have my blood tested to check the effects of this medicine on my body?
- What can trigger DH?
if you follow the diet to the letter. The severity and frequency of breakouts should decrease if you follow the diet well. Iodine can trigger breakouts in some people. However, iodine is an essential nutrient and should not be removed from the diet without the supervision of a doctor.
The most common disorder related to DH is disease of the thyroid gland. People with celiac disease are at high risk of developing autoimmune disorders such as Addison’s disease, type 1 diabetes, chronic autoimmune hepatitis, alopecia, Grave’s disease, myasthenia gravis , scleroderma, Sjogren’s syndrome, systemic lupus erythematosus and thyroid disease; this is not a complete list. Diseases of the thyroid gland and type 1 diabetes are the two most associated diseases. It is not unusual to have other skin conditions as well.