Dermatitis Herpetiformis: From the Genetics to the Development of Skin Lesions


Hey Guys, I decided to include this article about dermatitis herpetiformis because I know several people who suffer from this and this truly was the first sign that they recognized that there was a problem and sought out medical help. Their doctors ran a few tests and confirmed that they had celiac disease too and so their journey began.

  • Dermatitis herpetiformis (DH) is an autoimmune disease linked to gluten sensitivity with a chronic-relapsing course, characterized by pruritic polymorphic lesions and typical histopathological, immunopathological, and serological findings. It is currently considered to be the specific cutaneous manifestation of celiac disease (CD).
  • Patients with DH and CD share many common features such as gluten sensitivity, the same strong human leukocyte antigen (HLA) association, the presence of circulating IgA antitissue (tTG), and epidermal transglutaminase (eTG) antibodies [2]. Moreover, both DH and CD show the same typical histologic features of villous atrophy of the small bowel. In DH, the spectrum of enteropathy varies, and 20% of patients show apparently normal small-bowel mucosal architecture, but there are virtually always inflammatory changes consistent with latent CD.
  • The most commonly involved sites are the elbows (90%), knees (30%), shoulders, buttocks, sacral region, and face. Itching of variable intensity, scratching, and burning sensation immediately preceding the development of lesions are common
  • Both the rash and the enteropathy improve after a gluten-free diet (GFD).
  • The skin lesions of DH are characterized by the presence of an inflammatory infiltrate mainly composed by neutrophils, localized at the dermal papillary tips, the region where the cutaneous IgA deposits are found.
  • the development of skin lesions in DH could depend upon an ongoing mucosal immune response in the gut associated with elevated IL-8 levels and the production of a sufficient local concentration gradient of IL-8 and other chemokines (perhaps as a result of local trauma) that would attract “partially primed neutrophils” to the skin. The presence of IgA in the skin of patients with DH and the presence of IgA receptors on the surface of neutrophils suggest that IgA may function as an additional proinflammatory stimulus.

DH is extremely painful and oh so itchy. The only treatment is to go on a gluten free diet. The challenge becomes in controlling the itch and what you put on these outbreaks, you must be extremely careful not to aggravate this condition by putting any lotions or creams that have wheat, gluten, barley, rye or oats in it because most likely you will trigger off an extremely bad reaction in your whole body as these are like little open wounds that will go straight to your bloodstream. 

There is one prescription for Dapsone which several doctors are hesitant to prescribe unless a severe case due to the side effects and complications. When was the last time your doctor was hesitant to write you a prescription? So this truly sets off all kinds of alarm bells that unless you are having a severe outbreak maybe this is not the best option for you. Definitely talk to your doctor about your concerns. Just something to consider when dealing with a potential complication from your gluten-related disorder, whether it be celiac disease or gluten sensitivity. The only long-term solution is to remove gluten from your diet to stop the outbreaks of dermatitis herpetiformis.

For me personally the Dapsone was not even a question, I was having so many additional complications with my CD that I was having trouble pinpointing the causes for them and the thought of possibly adding to them was more than I could personally handle.  So I then went looking for an over the counter itch or eczema creams. And I read the side effects of many of these products and it clearly states that they may cause stinging, burning, irritation, dryness or redness at the application site.  Hello I was already having all of these issues, so if I were to try these how was I suppose to know if it was from the DH or now the darn cream? So I went a more holistic route and the only thing that I ever found that helped the itch was to take a high quality probiotic pill, open up the capsule, add a dab of water and make a paste (I also used a liquid probiotic and applied it with a cotton ball too) and applied that to the rash or bumpy area. It took a few days to stop the itching. I continued to do this a few times a day and I found that it led to less scaring, so yeah! Score one for yet another use for probiotics, not only do they help your insides but they help your outside as well. Hope this serves you and helps you too.

* Here’s my little disclaimer, I’m not a doctor, researcher, immunologist, just someone deeply concerned and trying to help as many peeps as I can make conscious, good, healthy choices for their health and their bodies when living life with gluten challenges. I have not been compensated or obligated to write this article, and as always, all thoughts and opinions are honest and my own!