What is dermatitis herpetiformis (DH)?
Dermatitis herpetiformis (DH) is an intensely itchy skin disease. It causes clusters of small blisters and bumps. It typically affects people in their 40s or 50s, but it can occur at any age. This lifelong condition affects more men than women.
What causes dermatitis herpetiformis?
Despite its name, the herpes virus does not cause DH.
DH is caused by an allergy 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.
Who is at risk for dermatitis herpetiformis?
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's syndrome
What are the symptoms of dermatitis herpetiformis?
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
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 doctor who specializes in the stomach and intestines (a gastroenterologist).
The symptoms of DH may look like other skin conditions. Always consult your health care provider for a diagnosis.
How is dermatitis herpetiformis diagnosed?
In addition to a medical history and physical exam, DH is usually confirmed with a skin biopsy and a specialized type of stain that helps to detect the IgA antibodies. You may also have a blood test.
How is dermatitis herpetiformis treated?
DH may be well-controlled with treatment. Specific treatment will be determined by your health care provider 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 DH may go away if you cut all gluten from your diet. Healing may take several weeks to months. Your health care provider may also prescribe a medication called Dapsone. This medication suppresses the skin response and may improve symptoms. However, the drug has some side effects, including anemia. If Dapsone is prescribed for you, your health care provider will carefully monitor your blood count.
Can dermatitis herpetiformis be prevented?
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 medications needed to manage the disease.
What are the complications of dermatitis herpetiformis?
People with DH often have celiac disease, which may develop into intestinal cancer. Thyroid disease may also develop.
Living with dermatitis herpetiformis
It is important to follow your health care provider’s recommendations about a gluten-free diet and medications. Iodine and some nonsteroidal anti-inflammatory drugs (NSAIDs) can trigger the condition. So, you may be told to avoid iodized salt and certain NSAIDs.
When should I call my health care provider?
If your symptoms worsen or you develop new symptoms, call your health care provider.
Key points about dermatitis herpetiformis
- Dermatitis herpetiformis (DH) is an intensely itchy skin disease. It causes clusters of small blisters and small bumps.
- DH is caused by an allergy to gluten.
- The symptoms of DH may clear when all gluten is cut from the diet.
Tips to help you get the most from a visit to your health care provider:
- 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
- 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.