Dermatitis herpetiformis (DH) is a severe, itchy, blistering skin manifestation of celiac disease. Not all people with celiac disease develop dermatitis herpetiformis. The rash usually occurs on the elbows, knees, and buttocks. Unlike other forms of celiac disease, the range of intestinal abnormalities in DH is highly variable, from minimal to severe. Only about 20 percent of people with DH have intestinal symptoms of celiac disease.
To diagnose DH, the doctor will test the person’s blood for autoantibodies related to celiac disease and will biopsy the person’s skin. If the antibody tests are positive and the skin biopsy has the typical findings of DH, patients do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into diet. In addition, the rash symptoms can be controlled with medications such as dapsone (4’,4’diamino-diphenylsuphone). However, dapsone does not treat the intestinal condition and people with DH should also maintain a gluten-free diet.
