Do you think my rash is caused by gluten?

At times, patients will come to the office with a rash that seems to correspond with eating foods that contain gluten. The name of the rash caused by a gluten sensitivity is dermatitis herpetiformis (DH).  So you say I have herpes?  No, the name of this rash often causes people to misunderstand and think that they have viral herpes. However, DH is not viral herpes, but rather is given the name dermatitis herpetiformis because of the clustered blisters that are present with the rash.

So what does dermatitis herpetiformis look like and how is it different than viral herpes?

DH commonly presents symmetrically, unlike viral herpes, on the scalp, shoulders, buttocks, elbows and knees. The skin can appear normal or reddened with raised bumps, sometimes fluid filled. The rash of DH is extremely itchy, but not usually painful like viral herpes.

Often the individual itches and scratches the areas of the rash, and once resolved are left with pigmentation that is either darker or lighter in the areas affected.

Sometimes, DH can resemble other skin rashes such as scabies or papular uticaria.

So if it is not a viral herpes infection, what causes dermatitis herpetiformis (DH)?

DH results from the intestines intolerance of a part of gluten that is found in wheat, rye, and barley. When the intestines come in contact with gluten, it causes antibodies to be produced and an autoimmune response that affects the intestines and the skin. In celiac disease, which affects the intestines, patients often have diarrhea, tiredness, and abdominal distention.  In DH, patients have a very itchy rash.

So how does a dermatologist diagnose me with dermatitis herpetiformis?

Often times, your dermatologist can have a probable diagnosis of DH based on presentation of the rash and your symptoms. To confirm the diagnosis, your dermatologist will need to do a skin biopsy.

If the results are positive for DH, your dermatologist or primary care doctor might order some other tests to check your thyroid and for nutritional deficiencies.

Is dermatitis herpetiformis contagious?

DH is not contagious and you can not transmit it to someone else like viral herpes.

 

How will my dermatologist treat dermatitis herpetiformis?

Most dermatologist will prescribe a strict gluten free diet. However, it may take 3 to 12 months for the symptoms to resolve. So sometimes your dermatologist will prescribe the oral medication known as dapsone. Dapsone works well to decrease the inflammation and suppress the disease, but is not a cure for the disease.

So the good news is patients with DH do not have a sexually transmitted infection that they can pass on to others. The bad news is their diet will be affected and gluten free products will become their new best friend.

To learn more check out these links

Dermnetz – Dermatitis Herpetiformis

 

By Aaron Santmyire APRN-BC, DNP

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