Dermatitis Herpetiformis (DH) is often referred to as coeliac disease of the skin. It is not common; about 10% of people with coeliac disease may develop DH. First presentation is usually between 30-40 years of age, more in adult males and rarely in children. It is rare to have DH without having coeliac disease.
DH occurs as clusters of small, intensely itchy blisters often found behind the knees, elbows, buttocks and scalp. The rash can flare on other parts of the body and the blisters contain a clear fluid.
When the rash is in this stage, a punch biopsy performed by a Dermatologist, is required to diagnose DH. The punch biopsy is looking for a particular pattern of IgA antibody deposits in the skin tissue that represents DH.
The rash is not contagious and flares up periodically. Sometimes the pigmentation of the skin in the areas of the rash are left purple immediately after the blisters go, and then later the continually affected skin is left brown or pale where the flares have subsided.
Most will experience the villi damage to the small bowel and either apparent uncomfortable gastrointestinal tract symptoms, or none at all. Some may also find changes occurring to their tooth enamel.
Dapsone medication is commonly used initially to give relief from the intense itch, but the potential side effects preclude its use long term.
The long-term treatment for dermatitis herpetiformis is to follow a life-long gluten free diet. On average it takes about 2 years on the gluten free diet before the DH skin condition can be controlled by diet alone. If you have dermatitis herpetiformis, even if you have few to no gut related symptoms, a small bowel biopsy should be done to confirm the diagnosis of coeliac disease before gluten is removed from the diet.
Kim can help you with dietary instructions.