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What Is Dermatitis Herpetiformis? Diagnosis, Symptoms, and Causes

Spencer Cailas

Gluten sensitivity or Celiac Disease has a whole range of symptoms that can manifest in more ways than what you can imagine.

That’s one of the reasons why the condition remains undetected for years in some people. Not everyone would be aware that the tingling sensation that they have been feeling in both arms and legs is linked to that pint of beer they have been enjoying every day.

That’s called neuropathy by the way, another strange symptom of Celiac disease.

One of the more commonly seen but extremely debilitating conditions is called Dermatitis Herpetiformis. The symptoms of this condition are as excruciating as pronouncing the name can be.

Dermatitis Herpetiformis is a form of Celiac that can cause extremely painful and itchy blisters on some parts of the body. Before we venture into how difficult the condition can be, let us give you the good news. (If you consider it good that is)

The extent of damage to the small intestines of people suffering from Dermatitis Herpetiformis is lesser than what usually occurs. In other words, instead of attacking the gluten protein in the small intestines, the immune system redirects the attack to the dermal layer or the skin.

What is Dermatitis Herpetiformis?

Dermatitis-Herpetiformis-1Typically, in Celiac, ingesting gluten in any form triggers an autoimmune response from the body that results in the formation of lgA antibodies. These antibodies mistake the gluten protein to be an external threat and start to attack it in the small intestines, damaging the villi (finger-like structures), which are responsible for the absorption of nutrients from our food.

The result is a horde of symptoms and conditions that are highlighted by the inability of the body to absorb nutrients.

In Dermatitis Herpetiformis however, rather than attacking the gluten protein in the small intestine, the lgA antibodies get deposited under the upper layer of the skin resulting in a group of red blisters that can be extremely itchy.

While the blisters are normally seen on areas like the knees, the back of the elbows and near the buttocks, newer cases have been detected off-late, in which the blisters have been seen even on the face and the scalp.

Dermatitis Herpetiformis can begin as early as 15 years but can occur at any age. It is more commonly seen in men than in women.

What are the symptoms of Dermatitis Herpetiformis?

Dermatitis Herpetiformis was first linked to Celiac in 1967, by using a gluten-free diet to stop the eruption of blisters on the body.

Until then, it was largely believed to be a chronic skin condition that can cause severely painful blisters.

The symptoms, well, one celiac sufferer puts it down in his own words like this.

‘It feels like rolling in stinging nettles naked with a severe sunburn, then wrapping yourself in a wool blanket filled with ants and fleas’

That would be the best way to describe how people with the condition feel when the blisters break out.

A lot of people mistake the blisters to be eczema because it is very similar in appearance. There are red bumps which are extremely itchy and usually have a uniform shape and size all over the body. Instead of blisters, some people experience a breakout that is characterized by scratch marks.

The only way to confirm if you have Dermatitis Herpetiformis is to undergo a small skin test.

How to diagnose Dermatitis Herpetiformis

To confirm that the symptoms are in fact Dermatitis Herpetiformis, doctors recommend a skin biopsy, in which, a small sized part of the skin (less than 4 mm in diameter) is removed from an area that is not affected by the blisters. This skin is then tested for the presence of IgA antibodies. The test is not painful and can be completed within minutes.

If antibodies are detected in the skin, then doctors may also recommend a biopsy of the small intestine and a blood test to confirm their diagnosis.

What is the treatment method?

Dermatitis Herpetiformis was first detected in 1884. It was linked to Celiac disease much later in 1964. Until then, the condition was purely treated with medication. Dapsone, an antibiotic drug that belongs to the category of Sulfones, has been effective in healing the blisters. It does not, however cure the condition. Also, the blisters recur when the drugs are discontinued. To control the condition with drugs, one would have to continue using the drugs for life which can be extremely hazardous and cause side effects.

Almost 25% of people have an adverse reaction when they use Dapsone. So, it is neither the safest nor the gentlest of medications that you can use.

The only way to completely stop the blisters from erupting is to follow a strict gluten free diet. To prevent outbreaks of the condition in future and prevent other health complications from happening, one must continue to adhere to a gluten free diet for life. This also prevents the need for using drugs to control the blisters.

However, it has been noted that it may take up to 6 months for a gluten-free diet to take effect in helping reduce the blisters. In some cases, patients have had to continue using the drugs for up to 2 years after switching to a gluten free diet.

The condition is one of the most stubborn ones to treat. Patience and persistence with constant monitoring is the only way to completely cure it.

Other possible complications

While Dermatitis Herpetiformis is not an autoimmune condition in itself, the incidence of an autoimmune disorder in DH patients is considerably higher. For this reason, it is possible that other conditions like diabetes and thyroid disease may develop, making it crucial to screen for these conditions on an annual basis.

Other than this, there are certain mild autoimmune conditions which may also develop in patients suffering from DH.

In extremely rare cases, Lymphoma, which is a type of cancer has been noted in DH.

The risk of autoimmune conditions developing can be considerably reduced with a strict gluten-free diet.