Gluten sensitivities can present itself in many ways, one of which is dermatitis herpetiformis (DH), a rare skin condition which affects only 10% of people with celiac disease (CD). What you are about to read will provide you with an improved understanding of DH and how to hopefully, better navigate the condition. We’ll be going through all aspects of DH, answering some of the most often asked questions many of you may have.

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Dermatitis herpetiformis (DH) is “celiac disease of the skin” and it is a manifestation of celiac disease (CD). It is a chronic skin condition with a characteristic rash with intense itching and burning sensations. Genetic factors, the immune system and sensitivity to gluten play a role in this disorder. The precise mechanisms remain unknown.

Around 5%- 10% of persons who have celiac disease will have DH as well. The common age at which DH appears is between 30-40 years, however, DH can also happen in children. Furthermore, for every one female, two males are diagnosed with DH. However, when under the age of 20, more females are diagnosed when compared to males.

The only sure way to know is to have a biopsy taken from uninvolved skin adjacent to blisters or erosions. Unlike celiac disease, one does not require a small intestinal biopsy to confirm the diagnosis. It is important to note that DH is often misdiagnosed with other skin conditions like eczema and or hives, therefore, it is very important to have a biopsy.

DH appears as a blistering rash which is symmetrically found on both sides of the body. Typical areas in which it is located include the elbows, knees and buttocks, but it can also appear on the hairline, scalp, back and neck. The rash initiates as a group of tiny blisters which eventually erupt into small erosions on the skin.

The treatment for DH is plain and simple; follow a strict gluten-free diet. An individual who has celiac disease and DH should never consume gluten, for life. By being gluten-free, gastrointestinal damage is resolved over the course of a couple months which results in a reduction of skin lesions. Additionally, a drug called “Dapsone” might be prescribed to lessen the itching. Medication is taken anywhere from six months to two years, after which DH goes into remission (no symptoms for 2 years without a gluten-free diet or medication). Based on how intense the rash is, it can take 1-2 weeks for rashes to disappear on a gluten-free diet.

Can you make DH worse by using lotions or cosmetics that contain gluten? The answer is no, like CD, unless you ingest gluten, there is no impact. The only thing to look out for in skincare products and cosmetics is iodine as this can worsen DH in some cases.

Being diagnosed with DH is painful and can be overwhelming. In a majority of cases, symptoms associated with DH are heightened with consumption of huge amounts of iodine. It is important to speak to medical doctors, dermatologists and registered dietitians about how to best manage the condition. It is also crucial that there are no short cuts or exceptions made on a gluten-free diet.

DH has a genetic predisposition which is marked by indicators such as the igA class of autoantibodies, specifically those found in granular deposits in the skin. This specific class of antibody’s plays a role in the immune function of mucous membranes. For this reason, DH is not contagious.

Psoriasis (condition which causes skin to multiply 10 times faster than usual) and DH are two separate conditions; however, it has been found that those who have CD have a higher risk of on-set for psoriasis. The link between psoriasis and CD has been deemed significant, so much so that it is recommended that patients who have psoriasis with bowel issues should be screened for CD.

If you are experiencing DH, it is a good idea to consult with a dermatologist who is an expert in CD. A dermatologist can help you determine the cause of your flare-ups and provide helpful advice about how to manage DH. They have updated knowledge about DH and can improve quality of life by explaining various treatment options

When an individual has CD, they tend to have oral indicators such as horizontal pits, grooves and discoloration in tooth enamel. These indicators tend to be visible in people who have DH as well. Additionally, patients who have DH usually have less gastrointestinal symptoms such as bloating and cramping than those who have only CD.

The implications of DH are the same as those for CD. Prior to being diagnosed with DH, one may experience nutritional deficiencies due to malabsorption. Moreover, patients who have DH, predominantly females, have a higher risk of having autoimmune thyroid disease. More specifically, roughly 20% of patients who have DH also have hyperthyroidism. In addition, those who have DH have shown to have a higher prevalence of other autoimmune diseases such as type 1 diabetes, vitiligo and sarcoidosis.

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The Canadian Celiac Association (CCA) exists to help those with celiac disease regain power over the disease, their bodies, and their lives. Thanks to the CCA Professional Advisory Council, the CCA is able to offer a singular, reliable source of information for Canadians living gluten free—and for their families and health care providers too.

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