Do you have a skin rash? If you do, you might have celiac disease. The “official” name of the skin condition is dermatitis herpetiformis (DH) and common symptoms include blistering skin and severe itching. DH is sometimes referred to as a gluten rash.
DH is a chronic condition, meaning that it can persist for a very long time. If you have celiac disease, this does not necessarily mean that you are going to develop DH. However, if you do, you are likely to get it around your joints, such as your elbows and knees, as well as around your buttocks.
The rash can also appear on other parts of the body, including the neck, face or groin area. In some cases, DH can affect the enamel on teeth.
It takes 1-2 weeks for your blisters to scab over and heal, but new blisters often grow in their place. Symptoms can die down and flare back up over time. Once you get DH, you usually have to deal with it for the rest of your life.
DH is typically symmetrical on the skin, so if you have it on one side of your body, it’s likely you already have, or will develop it, on the other side. Gluten rash also disappears spontaneously, and when it does, it may leave behind a pale or brown mark on your skin, where the pigmentation has been lost. It’s worth noting though that making skin contact with foods or other products containing gluten has not yet been proven to cause outbreaks of DH.
Who Gets Dermatitis Herpetiformis?
According to NHS Inform, DH affects fewer people than celiac disease, at around 1 in 10,000 people. It can also appear at any age but it’s more likely to be diagnosed if you are aged between 15 and 40. Of those that have been diagnosed with celiac disease, between 15 and 25 percent of them will experience symptoms of DH. A further 20 percent of people with DH will experience intestinal symptoms of celiac disease. However, of those that continue to eat a diet rich in gluten, 80 percent of them will experience damage to the small intestine. DH is also more commonly found in men than women. It is quite rare for children to be diagnosed with DH. It’s also most commonly found in those of European descent while being atypical among African-Americans and Asian-Americans.
How Can You Diagnose Dermatitis Herpetiformis?
Doctors and medical professionals can diagnose DH by closely examining skin cells underneath the top layer, known as the dermal papillae. Specifically, doctors would be looking for neutrophils and granular deposits of the Immunoglobulin (IgA) antibody. This chemical enters the bloodstream, building up in blood vessels under the skin. This is what triggers the DH rash. If doctors find traces of these antibodies, the skin biopsy is positive, meaning further tests are required to diagnose a patient with celiac disease.
60 percent of people living with DH don’t experience diarrhea, constipation or stomach pain but the majority of them will have the same damage to the gut as with celiac disease. To ensure that the test results are accurate, it is important to eat gluten-based foods until the biopsy and associated tests are completed.
One of the reasons DH is often misdiagnosed by healthcare professionals is because it shares similar symptoms with other rashes and outbreaks, like an allergic reaction, or skin conditions caused by insect or mosquito bites. It can also be misdiagnosed for another condition, such as herpes, eczema, and hives.
How Do You Treat Dermatitis Herpetiformis?
DH treatment is not just a one-off exercise. It requires a life-long commitment to avoid eating gluten-containing foods – exactly the same as managing celiac disease. However, compared to intestines’ response to a gluten-free diet with celiac disease, the skin’s response to a gluten-free diet takes a lot longer. In fact, it can take close to 6 months for your skin to show signs of improvement. It can also take another 2 years for the body to completely adjust to the gluten-free diet alone.
In terms of treating the rash, these symptoms can be controlled by using antibacterial medication. Once applied, the itching and new lesions will begin to subside. You should see signs of improvement within 48 to 72 hours after taking the medication. A common drug used to treat DH is dapsone. It is a tablet that must be swallowed and will help to control the symptoms, which will start working within days. Although, DH will come back if the drug is not taken before the gluten-free diet is in effect. There are a few side effects of dapsone to be aware of too. For example, the most common side effect is anemia, with less common side effects being suffering headaches, depression and even nerve damage.
DH should be monitored as drugs like dapsone could make the gut damage from celiac disease worse. For anyone that cannot tolerate dapsone, other drugs that can be used include sulphapyridine and sulphamethoxypyridazine. Drug treatment will only address the skin itching and blisters. It will not treat any other symptoms, so a gluten free diet is an essential part of the treatment of DH, as it is for anyone with celiac disease. This will not treat the intestinal condition though. For a successful intestinal treatment option, stay away from foods and products containing gluten.
Note that DH is a skin manifestation of celiac disease. It occurs due to the body’s abnormal immune response to gluten and is not connected to non-celiac gluten sensitivity.
There are a few home remedies that can be used to manage DH and celiac disease, particularly if anything is accidentally ingested that contains gluten. Some of the most recommended home remedies include omega-3 rich foods (example: spices such as turmeric and ginger), activated charcoal and herbal infusions. Of course, for anyone thinking of using any of these potential solutions, it’s always advised to consult a doctor beforehand. If you suspect that either you or a family member could have DH, please consider getting tested yourself with the imaware at-home celiac disease testing kit. It takes a little under 5 minutes to complete the test and the results are very accurate.