Dermatitis Herpetiformis

What is dermatitis herpetiformis (DH)?

Dermatitis herpetiformis (DH) is an intensely itchy skin disease. It causes clusters of small blisters and bumps. Symptoms typically start at age 30 to 40, but can happen at any age. This chronic autoimmune skin condition is rare in children. It affects more men than women.

What causes dermatitis herpetiformis?

Despite its name, the herpes virus doesn't 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 sets off an immune reaction. This causes material called IgA antibodies to be deposited 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 syndrome

• Lupus

What are the symptoms of dermatitis herpetiformis?

Each person may have different symptoms. These are the most common symptoms of DH:

• 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 cancer. Because of this, if you have celiac disease, it's 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.

How is dermatitis herpetiformis diagnosed?

In addition to a health 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 blood tests to find certain antibodies.

How is dermatitis herpetiformis treated?

DH may be well-controlled with treatment.

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

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. But the medicine has some side effects, including anemia. If dapsone is prescribed for you, your healthcare provider will carefully watch 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 staying away from foods that contain gluten. Sticking to a gluten-free diet can reduce the amount of medicines needed to manage the disease.

What are possible 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's important to follow your healthcare provider’s advice about a gluten-free diet and medicines. Iodine and some nonsteroidal anti-inflammatory drugs (NSAIDs) can set off the condition. So you may be told not to have iodized salt and certain NSAIDs.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, call your healthcare 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 a sensitivity to gluten.

• There is no known way to prevent this disease

• The symptoms of DH may clear when all gluten is cut from the diet.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• 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.