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  5. Dermatitis Herpetiformis and Gluten Intolerance: What Is The Connection?

Do you notice rashes on skin every time you consume wheat? An intolerance for gluten, a protein found in grains like wheat, can lead to a painful skin condition known as Dermatitis herpetiformis.

While maintaining a gluten-free diet helps, it needs medication for the symptoms to subside. Read on to know all about the facts, causes, symptoms and treatment options for the autoimmune disorder, Dermatitis herpetiformis.

What Is Dermatitis Herpetiformis?

People who have Celiac disease [1] commonly get an itchy rash known as Dermatitis herpetiformis [2]. Celiac disease is an autoimmune disorder that prevents the digestion of gluten, the protein present in grains like wheat.

When a patient consume gluten, the immune system in the intestines produces an antibody known as immunoglobulin A [IgA] [3]. It moves through the bloodstream to the surface of the skin and merges with the transglutaminase [4] protein in the skin, causing a reaction.

What Does Dermatitis Herpetiformis Look Like?

The rash appears like small bumps and it looks similar to eczema [5]. It shows up as blisters, which resemble those of herpes. Sores that resemble hives, full of fluid or raised on the skin may also appear.

One of the characteristics is prurigo [6], papules that are very itchy. Dermatitis herpetiformis sometimes shows up as purple or reddish brown spots in clusters known as digital petechiae [7].

Who Does Dermatitis Herpetiformis Affect?

Dermatitis herpetiformis affects more men than women, and rarely children. It usually shows up between the ages of 30-40 and is commonly observed in Caucasians (Europeans). Rarely, it can happen to Asian or African Americans.

Who Is At Risk Of Dermatitis Herpetiformis?

People who have Celiac disease are more at risk. However, it only affects 10-15% of those with Celiac disease. People who get Dermatitis herpetiformis don’t necessarily have any problems with their digestion or even a gluten sensitivity.

Studies reveal that Dermatitis Herpetiformis can be hereditary; 5% of immediate relatives of a person with this disease are likely to get it. Also, 5% of immediate family members of someone with Dermatitis Herpetiformis will have Celiac disease.

One of the most common autoimmune disorders linked with Dermatitis herpetiformis is hypothyroidism [8] among others. Some people who get Dermatitis herpetiformis also have a history of hereditary autoimmune disorders like vitiligo, alopecia areata, type 1 diabetes and even thyroid disease.

The Signs And Symptoms Of Dermatitis Herpetiformis

One of the first signs of Dermatitis herpetiformis is a burning feeling or a sensation like an insect’s sting on some parts of your body. This is followed by a rash.

Dermatitis herpetiformis appears on the scalp, joints like the knees, elbows and on the buttocks, shoulder blades and the back. It may even appear on the neck, genital area and the face.

Rash due to Dermatitis herpetiformis usually appears simultaneously on the left and right side of your body. It is known to even affect the enamel of your teeth.

Causes Of Dermatitis Herpetiformis

One of the primary causes is Celiac disease. When you consume gluten-based products, an antibody known as immunoglobulin A (IgA) is produced by your intestines. It triggers the DH rash when it travels through your blood vessels and gets collected under the skin.

Sometimes, a high iodine diet [9] (if you consume excess salt for example) can increase the rash and blisters and exacerbate other symptoms. Foods or medicines that have more than normal quantities of iodine can worsen your condition.

Treatment Options For Dermatitis Herpetiformis

While there is no cure for Dermatitis herpetiformis, some medications are known to help reduce the rash. A commonly prescribed oral medicine is Dapsone [10], which may reduce and stop the itching and rash within 3 days.

A topical corticosteroid may also be prescribed to reduce the itching. Other treatment protocols prescribed may include Sulfasalazine [11] or Sulfapyridine [12] if you are allergic to Dapsone. Maintaining a gluten-free and low iodine diet is imperative to keep Dermatitis herpetiformis under control.

The medication prescribed may need to be taken for a long time to prevent recurrence. The skin lesions caused due to the rash in Dermatitis herpetiformis can clear up if you strictly adhere to a gluten-free diet.

Note:

When you consult a dermatologist, make sure he is an authority on Celiac disease and its symptoms. A side effect of Dapsone, the medication prescribed for Dermatitis herpetiformis, is anaemia.

Complications Of Dermatitis Herpetiformis

If Dermatitis herpetiformis is left untreated and you have Celiac disease as well, it can increase your chances of different kinds of cancer of the gut as the intestines are inflamed all the time in this condition.

People who have Dermatitis herpetiformis are at an increased risk of Non-Hodgkin’s Lymphoma [13], a kind of cancer.

Since the intestines are not functioning at their optimum best, absorption of nutrients is compromised leading to anaemia and vitamin deficiency.

Other complications can include osteoporosis, increased possibility of being affected by autoimmune disorders like thyroid and type 1 diabetes.

Complications like thinning tooth enamel, pruritus or dry skin, nails and hair, fatty liver, neurological problems like epilepsy, losing balance or ataxia and cardiac problems like cardiomyopathy and pericarditis may occur.

Dermatitis herpetiformis may also lead to spontaneous and recurrent miscarriages.

Ulcers in the mucous membrane known as aphthous ulcers [14] or inflammation in the corners of the mouth known as angular cheilitis [15] are also possible complications.

How Is Dermatitis Herpetiformis Diagnosed?

The diagnosis is usually done with a biopsy of the skin. A small portion of your skin, where there is no rash, will be taken out by the doctor after locally anaesthetising it; sometimes, stitches are needed to close the cut. The stitches heal fast and hardly leave any scars.

The test will check if you have the IgA protein in a particular format. The pattern will confirm if you have Dermatitis herpetiformis. A blood test to check if you have Celiac disease also follows. If the latter is confirmed, you will be advised to eat gluten-free and maybe even salt free food.

Does Dermatitis Herpetiformis Come And Go?

Yes, based on your symptoms and your diet, Dermatitis herpetiformis can come and go. It recurs throughout one’s life and there is no saying when symptoms reappear, even if you are maintaining a strict gluten-free diet.

How Long Does Dermatitis Herpetiformis Last?

The rash can occur any time even if it may have subsided after a previous flare-up. It may take 8-15 days for the blisters to dry out, and the scabs to be formed. A flare-up means new blisters being formed on the old ones. It is a condition that needs lifelong management.

Wrapping Up

Though it is a rare condition, Dermatitis herpetiformis can be painful and needs careful management for a lifetime. Staying on a gluten-free, low iodine diet and medications can help ease the symptoms and prevent complications.

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