Celiac Disease and Skin Conditions: Dermatitis Herpetiformis

Celiac disease is a digestive disease that interferes with the absorption of nutrients and can damage the small intestine. Individuals with celiac disease cannot tolerate gluten, a protein in wheat, barley and rye. Although most of the symptoms of celiac disease involve the digestive process, it can also cause skin problems. Dermatitis herpetiformis (DH), one of the skin disorders associated with celiac disease, is a chronic skin condition considered the "skin manifestation of celiac disease."

Symptoms

The main symptom of DH is a blistering skin rash. It is characterized by small red bumps and blisters filled with a clear liquid. The rash is very itchy and the lesions might burn and sting. Lesions appear most often on the elbows, knees, buttocks, lower back, back of the neck and the head, however, they can appear anywhere on the body. It might start slowly or come on acutely and often is mirrored, showing up on the same area on both sides of the body.

Around 10 percent of those with celiac disease have DH, although most people with DH do not have classic symptoms of celiac disease, such as diarrhea, abdominal pain, vomiting and weight loss.

Diagnosis

Diagnosis of DH can be difficult. It is so itchy that you may scratch off the blisters, leaving small lesions or scarring which may look like other skin conditions. Your doctor might order a blood test for celiac disease and most people with DH will show positive results for celiac disease, however, this is not considered conclusive. Skin biopsies are considered a more effective way of diagnosing DH. Your doctor will excise a small portion of your unaffected skin, in an area close to the blisters.

DH is sometimes misdiagnosed as dermatitis, eczema, herpes, psoriasis, hives, mosquito or insect bites or diabetic pruritus.

Treatment

Like celiac disease, symptoms are triggered by consuming gluten. The only effective treatment is to be on a gluten-free diet. You should feel some relief from the itching within two to three days after beginning a gluten free diet. However, it may take weeks or months of eliminating gluten for all the symptoms to disappear.  As long as you stay away from foods containing gluten, you should be free of outbreaks.

Because it might take a long time for symptoms to disappear, Dapsone, a medication is sometimes prescribed. This medication does have side effects, such as nausea, flu-like symptoms, fatigue and sensitivity to light. Your doctor might begin you on a low dose and increase the dose slowly to reduce some of the side effects. This medication is not considered an alternative to a gluten-free diet.

References:

"Celiac Disease," Updated 2012, Juan. 27, Staff Writer, National Digestive Diseases Information Clearinghouse, National Institutes of Health

"Celiac Disease and Skin," Updated 2014, Jan 30, Staff Writer, National Foundation for Celiac Awareness