Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is “celiac disease of the skin”.  It is a chronic skin condition with a characteristic rash associated with severe itching and burning sensation.  The exact cause remains unknown but genetic factors, the immune system and sensitivity to gluten play a role in this disease.  

DH affects males and females equally and occurs in about 1:100,000 people. Onset is most commonly in the late second to the fourth decades of life. The most common areas affected include the elbows, knees, scalp, back of the neck, the upper back, and the buttocks.  The rash has a symmetric distribution.

The majority of individuals with DH have an abnormal mucosal lining of the small intestine similar to those changes seen in patients with celiac disease.  Most patients with DH have little or no bowel complaints.  Only a small number have abdominal pain, bloating and diarrhea.

DH can be diagnosed with a skin biopsy.  If this is not possible or there is doubt about the diagnosis, a small bowel biopsy is performed by a gastroenterologist.

The treatment of DH includes medications (e.g.; Dapsone) and a strict gluten-free diet.