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Although celiac disease is best known for its gastrointestinal symptoms, there is a lot more to the disease than just diarrhea or bloating.

In a subset of celiacs, the disease manifests in an extremely itchy autoimmune skin disease called dermatitis herpetiformis (DH), also called Duhring’s disease and referred to by some as a “gluten rash”.

It is important that every celiac know what the signs and symptoms of DH are, so that you can be sure to identify it and get the proper treatment.


What Does Dermatitis Herpetiformis Look Like?


Uncomfortable, or even painful, bumps and blisters filled with liquid form on the skin all over the body in affected individuals. These bumps and blisters are commonly found on joints like elbows and knees, as well as the hairline, back, groin and buttocks. They may itch and burn and be quite debilitating.

The rash may also take the form of scratch-like marks instead of blisters. Dermatitis herpetiformis is a chronic skin condition associated with celiac disease. Flare-ups of dermatitis herpetiformis are often associated with an uptick in the other symptoms of celiac disease as well.

This skin condition usually repeatedly breaks out in the same area of the body time after time, and may be constant or episodic. Small reddish or purple marks may be left behind as the bumps and blisters heal, which can take time to go away.


When and How Does DH Manifest Itself?


Dermatitis herpetiformis is found in people of all ages but generally develops in young adulthood. Men and women are both affected, but men are much more likely to develop DH despite celiac disease being more common in women. DH is diagnosed through a blood test for IgA antibodies and/or a skin biopsy, but doctors who suspect DH will often call for a biopsy of the small intestine to check for celiac disease as well.

Treatment includes antibiotic medications (specifically the antibiotic dapsone) and a strictly gluten-free diet. In some cases immunosupressants may be used. With a gluten-free diet and medication, DH clears up in most patients. It is likely to reappear if gluten is consumed.

Dermatitis herpetiformis is not dangerous in and of itself, but since it is accompanied by celiac disease, people with DH are at risk for a variety of complications including osteoporosis, anemia and every other condition celiacs are at increased risk of. In addition to celiac disease being commonly found in DH patients, autoimmune diseases such as Hashimoto’s thyroiditis, lupus, sarcoidosis and insulin-dependent diabetes are much more common in people with DH.

There is increased risk of certain intestinal cancers, as well. If you have DH your doctor may want to screen you regularly for various autoimmune diseases as well as recommending periodic colonoscopies and/or endoscopies. It is a good idea to consider the presence of DH to be an indicator that your immune system is not functioning properly and that you have an associated autoimmune disease. Anyone with one autoimmune disease is at risk of developing others.

This skin condition is the skin disorder most closely linked to celiac disease. However, keep in mind that other skin conditions such as psoriasis, eczema, hives, acne and alopecia areata have all been connected to celiac disease as well. If you have celiac disease or are gluten-intolerant, a strict gluten-free diet is the best way to ensure the health of your skin as well as the rest of your body.


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