Symptoms of Dermatitis Herpetiformis
On the surface of the skin, patients have clusters of water blisters (called vesicles or bullae) along with itchy red bumps on the skin. The dermatitis herpetiformis rash usually occurs on the elbows, lower back, buttocks, knees, and back of the head, but other areas of the body can also be affected.Before the rash begins, the skin feels like it’s burning. The blisters scab and heal in a week or two, but new spots continue to appear. Blisters that break can become infected.
Some patients have dermatitis herpetiformis in combination with celiac disease. Even without celiac disease, there can be intestinal damage of varying severity. In any case, the rash disappears when gluten is eliminated from the diet. Patients with dermatitis herpetiformis are at higher risk for other autoimmune disorders as well.
Diagnosis of Dermatitis Herpetiformis
Dermatitis herpetiformis can be difficult to diagnose. Examples of the rashes can be seen in these photographs:
- Dermatitis herpetiformis: close-up of lesions
- Dermatitis herpetiformis on the thumb
- Dermatitis herpetiformis on the hand
- Dermatitis herpetiformis on the knee
- Dermatitis herpetiformis on the arm and legs
- Dermatitis herpetiformis on the forearm
In patients with dermatitis herpetiformis, immunoglobulin A (IgA) deposits can be found under the skin. The diagnosis of dermatitis herpetiformis usually requires at least one skin biopsy to look for the immunoglobulin A (IgA), and sometimes the same blood tests used to diagnose celiac disease.
According to the NIH Consensus Development Conference on Celiac Disease Conference Statement, patients with biopsy-proven dermatitis herpetiformis whose celiac antibody blood tests are positive do not need to have an intestinal biopsy to confirm the diagnosis of celiac disease.
Treatment of Dermatitis Herpetiformis
Once gluten is eliminated from the diet, the dermatitis herpetiformis rashes can still take several months to heal and disappear. In the meantime, to manage the inflammation, doctors can prescribe a very effective medication called dapsone. Dapsone can cause anemia, however, so patients taking it will need to have their blood monitored regularly. For patients who can’t take dapsone, there are other less effective medications.Dermatitis herpetiformis is a lifelong condition. To be cured of the painful rashes and to reduce the risk of other serious medical problems, patients must become and remain completely gluten-free.
Sources:
American Osteopathic College of Dermatology.
Penn State Milton S. Hershey Medical Center College of Medicine.
University of Virginia Health System.
