What is dermatitis herpetiformis? And how it is related to celiac disease?

A rash is a symptom which causes the affected area of your skin to turn red and to swell. It may cause spots which are bumpy, scaly, flaky, or filled with pus. Rashes can vary in pattern, location, and extent. It may occur in any area of your body.

A rash shows any abnormal change in skin texture or color. Usually, rashes are caused by skin inflammation that can have many causes. There are certain types of rashes associated with skin conditions, comprising eczema, lichen planus, granuloma annulare, and pityriasis rosea.

The common location for psoriasis eruptions is an elbow, which causes inflammation and scaly white spots. Rashes can also be caused by an allergic reaction to food, medications, lotions or detergents.

What is dermatitis herpetiformis?

A dermatitis herpetiformis(DH) is an itchy, blistering, burning skin rash which is a difficult state to live with. The rash and itching usually occur on the elbows, knees, back, scalp, and buttocks. The rash likely specifies gluten intolerance, which may be associated with a more serious underlying condition called celiac disease.

Gluten is a protein found in grasses of the species Triticeae, which comprises rye, barley, and wheat. Gliadin protein found in these grains is high-affinity substrates for tissue transglutaminase (TTG).

Gliadins can also be found in oats, rice, and corn, but these proteins are poor substrates for TTG. Thus, these tend to be tolerated. Strict compliance with a gluten-free diet causes normalization of the small bowel mucosal changes and control of the cutaneous expressions of dermatitis herpetiformis in most patients.

Dermatitis herpetiformis is sometimes called Duhring’s disease or gluten rash is a chronic autoimmune blistering skin condition. People having this condition should maintain a strict gluten-free diet.

Causes of dermatitis herpetiformis

Mostly, people think that this rash is caused by some form of the herpes virus. But actually, it has nothing to do with herpes. Dermatitis herpetiformis occurs in individuals with celiac disease.

Celiac disease also called celiac sprue, gluten intolerance, or gluten-sensitive enteropathy. It is an autoimmune disorder which is characterized by intolerance to gluten. Gluten is a protein present in rye, wheat, and barley. Sometimes, it is also found in oats which have been processed in plants that handle other grains.

According to the National Institutes of Health (NIH), 15 to 25% of people with celiac disease have dermatitis herpetiformis. Celiac disease can also cause complications like intense abdominal pain, nausea, constipation, and vomiting.

People with DH normally don’t have any of the intestinal symptoms. Though, even if they don’t experience intestinal symptoms, 80% or more of people with DH still have intestinal damage, particularly if they eat a high gluten diet, according to the National Foundation for Celiac Awareness (NFCA).

Basically, the intestinal damage or rash occurs due to the reaction of gluten proteins with an antibody called immunoglobulin A (IgA). These IgA antibodies are made by our body to attack gluten proteins. When IgA antibodies attack gluten, they harm the intestinal parts which allow you to absorb nutrients and vitamins.

The structures formed on IgA attachment to gluten enter the bloodstream. There, they begin to block small blood vessels, particularly those in the skin. White blood cells then move towards these clogs. A chemical called “complement” is then released by the white blood cells which cause an itchy, blistery rash.

Who is at risk for dermatitis herpetiformis?

Celiac disease can affect anyone. But it tends to be more common in those who have any family member with DH or celiac disease.

According to the NIH, no doubt more women than men are diagnosed with celiac disease but men are more likely to develop DH than women. Usually, the rash begins in the 20s or 30s, though it can start in childhood. The condition more commonly occurs in people of European ancestry. It is less common in people of Africa or Asia. The following diseases can also increase your risk of DH;

  • Autoimmune thyroid disease
  • Celiac disease
  • Type 1 diabetes
  • Sjögren syndrome
  • Lupus

Symptoms of dermatitis herpetiformis

In dermatitis herpetiformis, the first thing you will possibly notice is a scorching or stinging feeling on certain places on your skin. After which, clusters of small, red bumps arise. They are very itchy and can take a number of forms, such as;

  • Blisters
  • Fluid-filled sores
  • Sores that look like hives
  • Raised sores

DH is one of the itchiest rashes possible. Common locations of the rash on your skin are as follows;

  • elbows
  • knees
  • lower back
  • hairline
  • back of the neck
  • shoulders
  • buttocks
  • scalp

Usually, the rash is of same size and shape on both sides of your body and it often comes and goes. Before its full outbreak, you may feel the skin in a crash-prone area itch or burn. It causes the formation of bumps which look like pimples filled with clear liquid. These are scratched off quickly.

Within a few days, these bumps heal leaving a purple mark which lasts for weeks. However new bumps continue to form as old ones settle. This process can continue for years, or it can go into reduction and then reappearance.

Though these symptoms are usually related to dermatitis herpetiformis, they can also be caused by other skin illnesses like psoriasis, atopic dermatitis, irritant or allergic contact dermatitis, pemphigoid, or scabies. Some patients with dermatitis herpetiformis may also experience dental enamel faults to permanent teeth. This is another manifestation of celiac disease.

Treatments for dermatitis herpetiformis

Dapsone is an antibiotic used for the treatment of dermatitis herpetiformis. Dapsone is strong medicine with severe side effects.

The dose must be increased gradually over several months before it is fully operative. Mostly, people see release after taking dapsone, but side effects may include;

  • liver problems
  • sensitivity to sunlight
  • anemia
  • muscle weakness
  • peripheral neuropathy

This antibiotic may also have adverse reactions with other medications, like aminobenzoate potassium, clofazimine, or trimethoprim. Other drugs used for this include tetracycline, sulfapyridine, and some immunosuppressive drugs. But these drugs are less effective than dapsone.

Moreover, the most effective free of side effects treatment is strict adherence to a gluten-free diet. It means you must completely avoid food, drink, or medicines comprising the following;

  • wheat
  • rye
  • barley
  • oats

Though this diet can be hard to follow it will have the most helpful effect on your health if you have celiac disease. Reduction in gluten intake may also help reduce the medication you will need to take.

Areeba Hussain

Areeba is an independent medical and healthcare writer. For the last three years, she is writing for Tophealthjournal. Her prime areas of interest are diseases, medicine, treatments, and alternative therapies. Twitter @Areeba94789300

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