Dermatitis herpetiformis (DH) is an intensely itchy skin disease. It causes clusters of small blisters and bumps. It typically affects people in their 30s to 50s, but it can happen at any age. This lifelong condition affects more men than women.
Despite its name, the herpes virus does not cause DH.
DH is caused by a sensitivity or intolerance to gluten. Gluten is a protein found in wheat and grains. When you have DH and eat food with gluten, the gluten combines with an antibody from the intestines. As the gluten and antibody circulate in the blood, they clog small blood vessels in the skin. This is what causes the rash.
DH is found most often in people of northern European heritage. The following diseases increase your risk of DH:
- Autoimmune thyroid disease
- Celiac disease
- Type 1 diabetes
- Sjögren syndrome
The following are the most common symptoms of DH. However, each person may experience symptoms differently. Symptoms may include:
- Clusters of itchy, small blisters and bumps, mostly on the elbows, lower back, buttocks, knees, and back of the head
- Severe itching and burning
- Erosions and scratches are often seen on the skin
The gut may also have the same allergy to gluten. This is known as celiac disease. You can have both DH and celiac. Some cases of celiac become cancerous. Because of this, if you have celiac disease, it is important to see a healthcare provider who specializes in the stomach and intestines (a gastroenterologist).
The symptoms of DH may look like other skin conditions. Always talk with your healthcare provider for a diagnosis.
In addition to a medical history and physical exam, DH is usually confirmed with a skin biopsy and a specialized type of immunofluorescent stain that helps to detect the IgA antibodies. You may also have a blood tests to find certain antibodies.
DH may be well-controlled with treatment. Specific treatment will be determined by your healthcare provider based on:
- Your age, overall health, and medical history
- Extent of the condition
- Your tolerance for specific medicines, procedures, and therapies
- Expectation for the course of the condition
- Your opinion or preference
The symptoms of DH may go away if you cut all gluten from your diet. Healing may take several weeks to months. Your healthcare provider may also prescribe a medicine called dapsone. This medicine suppresses the skin response and may improve symptoms. However, the medicine has some side effects, including anemia. If dapsone is prescribed for you, your healthcare provider will carefully monitor your blood count.
There is no known way to prevent this disease. You may be able to prevent complications by avoiding foods that contain gluten. Although difficult, sticking to a gluten-free diet can reduce the amount of medicines needed to manage the disease.
People with DH often have celiac disease, which may develop into intestinal cancer. Thyroid disease may also develop.
It is important to follow your healthcare provider’s recommendations about a gluten-free diet and medicines. Iodine and some nonsteroidal anti-inflammatory medicines (NSAIDs) can trigger the condition. So, you may be told to avoid iodized salt and certain NSAIDs.
If your symptoms worsen or you develop new symptoms, call your healthcare provider.
- Dermatitis herpetiformis (DH) is an intensely itchy skin disease. It causes clusters of small blisters and small bumps.
- DH is caused by a sensitivity to gluten.
- The symptoms of DH may clear when all gluten is cut from the diet.
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
January 16, 2018
Dermatitis Herpetiformis Part I: Epidemiology, pathogenesis, and clinical presentation. Bolotin D. Journal of the American Academy of Dermatology. 2011; (64)6:1017-24., Dermatitis Herpetiformis Part II- Diagnosis, Management, and Prognosis. Bolotin D. Journal of the American Academy of Dermatology. 2011; (64)6:1027-33.
Lehrer, Michael Stephen, MD ,Finke, Amy, RN, BSN