Dermatitis herpetiformis

By Medically reviewed by Panel Perubatan Hello Doktor


What is dermatitis herpetiformis?

Dermatitis herpetiformis (DH), characterized by itchy, blistering, burning skin rashes, is a difficult condition to live with. The rash and itching usually occur on the elbows, knees, scalp, back, and buttocks. This rash possibly indicates gluten intolerance, which may be associated with a more serious underlying condition known as celiac disease. DH is sometimes called Duhring’s disease or gluten rash. People who have this illness need to maintain a strict gluten-free diet.

How common is dermatitis herpetiformis?

More women than men are diagnosed with this disease, and men are more likely to develop DH than women. The rash usually begins in your 20s or 30s, though it can start in childhood. The condition more commonly occurs in people of European descent. On the other hand, it less commonly influences people of African or Asian descent.

Please discuss with your doctor for further information.


What are the symptoms of dermatitis herpetiformis?

DH is considered as one of the itchiest rashes possible. Some popular locations of the rash include:

  • Elbows
  • Knees
  • Lower back
  • Hairline
  • Back of the neck
  • Shoulders
  • Buttocks
  • Scalp

The rash is usually the same size and shape on both sides of the body and often comes and goes.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes dermatitis herpetiformis?

From the sound of the name, many people possibly think this rash is caused by some form of the herpes virus. This isn’t the case, as it has no relation with herpes. Many doctors prove that dermatitis herpetiformis occurs in people with celiac disease. Celiac disease (also called celiac sprue, gluten intolerance, or gluten-sensitive enteropathy) is an autoimmune disorder characterized by intolerance to gluten, which is a protein found in wheat, rye, and barley and is also sometimes found in oats that have been processed in plants that handle other grains.

According to the National Institutes of Health (NIH), 15 to 25 percent of people with celiac disease have DH. Celiac disease can also cause intense abdominal pain, constipation, nausea, and vomiting. People with DH typically don’t have any of the intestinal symptoms. However, even if they don’t experience any intestinal symptoms, 80 percent or more of people with DH still have intestinal damage, especially if they eat a diet that’s high in gluten, according to the National Foundation for Celiac Awareness (NFCA).

The intestinal damage and rash are due to the reaction of gluten proteins with a typical kind of antibody called immunoglobulin A (IgA). Your body makes IgA antibodies to attack gluten proteins. When IgA antibodies attack gluten, they destroy the parts of the intestines that enable you to absorb vitamins and nutrients. It is believed that this sensitivity to gluten usually runs in families.

The structures formed when IgA attaches to gluten then enter the bloodstream. They start to clog small blood vessels, especially those in the skin. White blood cells are attracted to these clogs. The white blood cells release a chemical called “complement” that causes an itchy, blistery rash.

Risk factors

What increases my risk for dermatitis herpetiformis?

Celiac disease can affect anyone, but it tends to be more common in people who have another family member with celiac disease or DH.

Although more women than men are diagnosed with celiac disease, men are more likely to develop DH than women, according to the NIH. The rash usually begins in your 20s or 30s, though it can start in childhood. The condition more commonly occurs in people of European descent. It less commonly affects people of African or Asian descent.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is dermatitis herpetiformis diagnosed?

If your doctor suspects that you may experience this condition, a physical examination will be performed and some tests will be also recommended by your doctor. Tests and procedures used to diagnose dermatitis herpetiformis may include:

Skin biopsy

A doctor takes a small sample of skin and examines it under a microscope. Sometimes, a direct immunofluorescence test is done, in which the skin around the rash is stained with a dye that will show the presence of IgA antibody deposits. The skin biopsy can also help determine if the symptoms are caused by another skin condition.

Blood tests

It helps the doctor to check for these antibodies in the blood. An intestinal biopsy may be performed to confirm the presence of damage due to celiac disease.

Patch testing

In case the diagnosis is uncertain, or another diagnosis is possible, other tests may be performed. Patch testing is the best way to diagnose allergic contact dermatitis, which is a common cause of symptoms similar to dermatitis herpetiformis.

How is dermatitis herpetiformis treated?

DH can be cured with an antibiotic called dapsone, which is a powerful medicine with serious side effects. The dose must be increased slowly over several months before it is fully effective. Most people see relief from taking dapsone, but some serious side effects may include:

  • Liver problems
  • Sensitivity to sunlight
  • Anemia
  • Muscle weakness
  • Peripheral neuropathy

Other drugs that may be used include tetracycline, sulfapyridine, and some immunosuppressive drugs. However, these are less effective than dapsone.

It is obvious that the most effective treatment that is free of side effects is strict adherence to a gluten-free diet. This means you should completely avoid food, drink, or medicines containing the following: wheat, rye, barley, oats, etc.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage dermatitis herpetiformis?

The following lifestyles and home remedies might help you cope with this condition:

  • Avoid food and drinks containing barley, bulgur, durum,  farina, graham flour
  • Packaged foods should be avoided unless they’re labeled as gluten-free or have no gluten-containing ingredients.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.