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Dermatitis Herpetiformis

What is dermatitis herpetiformis (DH)?

Dermatitis herpetiformis is an intensely pruritic (itchy) skin disease characterized by eruptions of clusters of small blisters or vesicles (small elevations of the skin containing fluid) and small bumps or papules (small, solid, elevations on the skin). Dermatitis herpetiformis typically presents in the fourth of fifth decade of life, although it can occur at any age. It affects more men than women, and is a lifelong condition. 

What triggers DH?

Despite its name, the herpes virus does not cause DH. Dermatitis herpetiformis is caused by an allergy to gluten. When gluten, a protein found in wheat and grains, is consumed, it combines with IgA (an antibody) from the intestines and they begin to circulate in the bloodstream together. They ultimately end up clogging small blood vessels in the skin, causing a rash to develop. The disease typically occurs in people of northern European heritage. People with DH often have a high incidence of autoimmune thyroid disease.

There is no known way to prevent this disease. People who suffer from DH may be able to prevent complications by avoiding foods that contain gluten. Although this is very difficult to do, adherence to a gluten-free diet can reduce the amount  of medications needed to manage the disease. 

What are the symptoms of DH?

The following are the most common symptoms of dermatitis herpetiformis. However, each individual may experience symptoms differently. Symptoms may include:

  • Clusters of itchy, small blisters, mostly on the elbows, lower back, buttocks, knees, and back of the head

  • Itching and burning are often severe

The gut may also have the same allergy to gluten. This is known as celiac disease or gluten sensitive enteropathy (GSE). A person can have both GSE and DH together or only one. Some cases of GSE become cancerous. Because of this, if you have celiac disease, it is important to have an evaluation by a doctor who specializes in the stomach and intestines (a gastroenterologist). 

The symptoms of DH may resemble other skin conditions. Always consult your doctor for a diagnosis.

How is DH diagnosed?

In addition to a medical history and physical examination, DH is usually confirmed with a skin biopsy with immunofluorescence (a specialized type of stain that helps to detect the presence of IgA antibodies) and sometimes a blood test.

Treatment for DH

Dermatitis herpetiformis may be well-controlled with treatment. Specific treatment for DH will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the condition

  • Your opinion or preference

The symptoms of dermatitis herpetiformis may clear when all gluten is eliminated from the diet, although healing may take several weeks to months. Treatment may also include drug therapy. Dapsone, a medication which can improve symptoms by suppressing the skin response, may be prescribed. However, dapsone has been associated with some side effects, especially anemia. If Dapsone is prescribed for you, your doctor will carefully monitor your blood count.