Gluten rash (also called dermatitis herpetiformis, DH, and Duhring’s disease) is a rare, chronic, autoimmune skin condition that occurs in people with celiac disease that is a manifestation of gluten sensitivity.
A gluten rash commonly develops on the elbows, knees, buttocks, lower back, and scalp. The face and groin may be affected less frequently.
Symptoms of a gluten rash include:
- Rash that looks like red, raised skin lesions/blisters
- Sores that look like hives
- Lesions occur in groups
- Severe itching
- Rash is usually symmetrical and appears on both sides of the body
Other symptoms of dermatitis herpetiformis include:
- Defects in tooth enamel: horizontal grooves, pits, or tooth discoloration
- Oral ulcerations (canker sores) (rare)
- Gastrointestinal symptoms
- Abdominal bloating, cramping, or pain
- Diarrhea
- Constipation
What Causes Gluten Rash?
Gluten rash is caused by a complex combination of genetic and environmental factors.
- Genetics: first-degree relatives of patients have an increased risk of both gluten rash (dermatitis herpetiformis) and celiac disease
- Environment: dietary gluten
How Is Gluten Rash Diagnosed?
Gluten rash (dermatitis herpetiformis) is diagnosed with a patient history and physical examination and a skin biopsy for direct immunofluorescence microscopy (DIF).
Antibody protein (IgA) deposits are found within the dermis of 92% of patients who have dermatitis herpetiformis.
Blood tests may be used to support the diagnosis and to monitor if a person is following to dietary therapy recommendations:
- Enzyme-linked immunosorbent assay (ELISA) for IgA tissue transglutaminase antibodies
- ELISA for IgA epidermal transglutaminase antibodies (when available)
- Indirect immunofluorescence for IgA endomysial antibodies
- Total IgA level
What Is the Treatment for Gluten Rash?
The mainstay of treatment for gluten rash (dermatitis herpetiformis) is a strict gluten-free diet and often the antibiotic dapsone. Dapsone usually helps clear symptoms quickly, and the dose can be reduced if patients adhere to a strict gluten-free diet.
Other medications used to treat gluten rash in patients unable to take dapsone include:
- Sulfapyridine
- Topical corticosteroids (used short-term)
A dermatologist usually helps manage the skin manifestations of gluten rash, while consultation with a dietician may be recommended to help patients identify and eliminate both sources of dietary gluten, and to find alternatives to gluten-containing foods.
What Are Complications of Gluten Rash?
Gluten rash (dermatitis herpetiformis) is a condition that occurs in people who have celiac disease, and complications are similar to those of celiac disease, including:
- Osteoporosis
- Increased risk of other autoimmune disorders such as type 1 diabetes and thyroid disease
- Intestinal cancer
- Side effects from dapsone treatment
- Ruptured red blood cells (hemolysis)
- Methemoglobinemia
- Peripheral neuropathy
- Severe low white blood cell count (agranulocytosis)
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