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 30s to 50s, but
it can happen 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 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 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 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
- 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 cancerous. Because of
this, if you have celiac disease, it is 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 medical 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 a blood tests to find certain antibodies.
How is dermatitis herpetiformis treated?
DH may be well-controlled with treatment. Specific treatment will be determined by
your healthcare provider based on:
- Your age, overall health, and medical history
- Extent of the condition
- Your tolerance for specific medicines, 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 healthcare provider may also prescribe a medicine called
dapsone. This medicine suppresses the skin response and may improve symptoms. However,
the medicine has some side effects, including anemia. If dapsone is prescribed for
you, your healthcare 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 medicines 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 healthcare provider’s recommendations about a gluten-free
diet and medicines. Iodine and some nonsteroidal anti-inflammatory medicines (NSAIDs)
can trigger the condition. So, you may be told to avoid iodized salt and certain NSAIDs.
When should I call my healthcare provider?
If your symptoms worsen or you develop 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.
- 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 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
- 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
- Know how you can contact your provider if you have questions.