Causes and Treatments of Dermatitis Herpetiformis (DH) | Dermatology

Dermatitis herpetiformis (DH)

What is dermatitis herpetiformis?

Dermatitis herpetiformis (DH) is an itchy, bumpy rash that is common in people with celiac disease. This is an autoimmune disorder that prevents your body from digesting gluten, a protein found in wheat and other grains.

Dermatitis herpetiformis, otherwise called dühring’s malady, causes herpes-like rankles, however, the condition doesn’t originate from the herpes infection. It is linked to gluten sensitivity.

What are the symptoms of dermatitis herpetiformis?

Dermatitis herpetiformis is one of the itchiest rashes possible. Include common sites of rash:

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

The rash is usually the same size and shape on both sides of the body and often comes and goes. Before the rash fully breaks out, you may feel burning or itchy skin in an area prone to the rash. Blister-like bumps filled with a clear fluid begin to form. These are quickly scratched. The bumps heal in a few days and leave a purple mark that lasts for weeks.

But the new bumps continue to form as the old heal. This process can last for years, or it can turn into remission and then return. While these symptoms are most commonly associated with dermatitis herpetiformis, they can also be caused by other skin conditions such as atopic dermatitis, irritant or allergic contact dermatitis, psoriasis, pemphigus, or scabies.

What causes dermatitis herpetiformis?

Although doctors still don’t fully understand what causes dermatitis herpetiformis, it’s possible that genetics and lifestyle factors play a role. For a long time, doctors did not know what caused this rash, which made the condition difficult to deal with. Experts then noted that dermatitis herpetiformis symptoms decreased significantly in people who changed their diet to include little or no gluten.

This observation led to the discovery that dermatitis herpetiformis had a strong association with gluten sensitivity. Gluten is a protein found in grains that include wheat, rye, and barley.

An example of foods containing gluten is:

  • Bread
  • Pastries
  • Baked goods
  • Noodles
  • Pasta
  • Cereals

Some studies show that close relatives of people with dermatitis herpetiformis are at an increased risk of developing the condition themselves.

Diagnosis of DH

Dermatitis herpetiformis can be difficult to diagnose – it may be confused with more common skin conditions that cause itchings, such as eczema and scabies. When the condition is suspected, a skin biopsy is usually taken to confirm the diagnosis. This is where a small skin sample is taken under local anaesthesia for microscopic analysis. This may be important, as treatment involves a change in diet and can require long-acting tablets.

Usually, blood tests are also done. Sometimes, a small biopsy may also be taken of the inside lining of the intestine to check the type of inflammation that appears in celiac disease. If necessary, this examination is performed by a gastroenterologist (bowel specialist).

What is the treatment for dermatitis herpetiformis?

There is no cure for dermatitis herpetiformis, but medications can help treat the rash. Your doctor may prescribe dapsone, which you take by mouth. It gets rid of itching and bumps within 1-3 days. Your primary care physician may likewise prescribe a skin corticosteroid cream to help with tingling.

If the tests show that you have celiac disease, your doctor will tell you to completely cut gluten from your diet. Iodine, a typical fixing in salt, can aggravate indications at times. So you may need to avoid that as well

Gluten-free diet

A gluten-free diet is highly recommended for life in patients with dermatitis herpetiformis, as:

  • To reduce the need for medications to control dermatitis herpetiformis
  • Improves intestinal inflammation associated with gluten sensitivity
  • Enhances nutrition and bone density
  • It may reduce the risk of developing other autoimmune diseases
  • It may reduce the risk of developing intestinal lymphoma


Dapsone is the treatment of choice for dermatitis herpetiformis, as it usually reduces the itching within 3 days.

  • The dose ranges from 25 mg to 300 mg daily
  • Dapsone has potential side effects and needs monitoring
  • It may be gradually weaned off in those who follow a consistent gluten-free diet

If you are allergic to dapsone, the following may be helpful:

  • Ultra-potent topical steroids
  • Sulfapyridine (not available in New Zealand)
  • Systemic steroids
  • Rituximab

What is the outcome of dermatitis herpetiformis?

DH typically has a decent forecast, with most of the patients reacting admirably to an exacting sans gluten diet and drug. Response rate varies between individuals (days to years).

Who is at 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 dermatitis herpetiformis.

Although more women than men have celiac disease, men are more likely to have DH than women, according to the national institutes of health. The rash usually begins in your 20s or 30s, although it can start in childhood. The condition occurs more commonly in people of European descent. Less common is the effect on people of African or Asian descent.


The same conditions and complications associated with people with DH can occur as in people with celiac disease.

Some of the potential complications of DH include:

  • Osteoporosis
  • Certain kinds of gut cancer
  • An increased risk of developing other autoimmune diseases, such as type 1 diabetes and thyroid disease

As with celiac disease, your risk of developing it is reduced with a gluten-free diet.


There is no realized method to forestall this infection. You may be able to prevent complications by avoiding foods that contain gluten. Although difficult to stick to a gluten-free diet, it can reduce the amount of medication needed to manage the disease.

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