Dermatitis herpetiformis, also known as a gluten rash, is an intensely itchy, blistering rash that affects a significant number of people withceliac disease.Celiac disease is anautoimmunedisorder in whichgluten, a protein found in some cereal grains, causes theimmune systemto attack itself. With celiac disease, thesmall intestineis the target of the assault. Dermatitis herpetiformis is an extension of the disease in which the skin is attacked.This gallery of images can help you identify the signs and symptoms of dermatitis herpetiformis. It also describes other rashes that look like dermatitis herpetiformis and what is involved in the diagnosis and treatment of this immune-related skin condition.
Dermatitis herpetiformis, also known as a gluten rash, is an intensely itchy, blistering rash that affects a significant number of people withceliac disease.
Celiac disease is anautoimmunedisorder in whichgluten, a protein found in some cereal grains, causes theimmune systemto attack itself. With celiac disease, thesmall intestineis the target of the assault. Dermatitis herpetiformis is an extension of the disease in which the skin is attacked.
This gallery of images can help you identify the signs and symptoms of dermatitis herpetiformis. It also describes other rashes that look like dermatitis herpetiformis and what is involved in the diagnosis and treatment of this immune-related skin condition.
Dermatitis Herpetiformis Symptoms
Dermnet/Creative Commons
Dermatitis herpetiformis can look like other skin conditions, but there are certain characteristics that provide clues that celiac disease may be involved:
Location
Although dermatitis herpetiformis can develop on any part of the body, it is most commonly seen on theextensor surfaces(the skin on the outside of joints), such as theelbows, knees, buttocks, ankles, groin, and back of the neck.
Onset of Symptoms
Dermatitis herpetiformis develops suddenly and can last for weeks to months. Outbreaks can occur within hours or days of eating gluten.
Appearance
The dermatitis herpetiformis rash has distinctive reddish-purple, fluid-filled bumps that can be as small as a pinhead or as large as a dime.
Sensations
During outbreaks, a person may be unable to resist scratching. This can cause scarring and the appearance of reddish skin and purplish marks that can last for weeks or months, or be permanent.
Symmetry
As with autoimmune diseases likerheumatoid arthritisandvitiligo, dermatitis herpetiformis develops symmetrically, meaning that it affects the same skin surface on both sides of the body at once.
How Celiac Disease Is Diagnosed
Severe Dermatitis HerpetiformisCenters for Disease Control and PreventionThis photo shows a severe case of dermatitis herpetiformis in a 4-year-old child.Dermatitis herpetiformis most often starts between the ages of 30 and 40, though people of any age can be affected.The condition had long been considered rare in children under 10, but more cases have been identified in recent years.Most cases arechronic(persistent or recurrent), with the frequency of outbreaks varying from one person to the next. In the majority of cases, the outbreaks will occur on the same part of the body every time.
Severe Dermatitis Herpetiformis
Centers for Disease Control and Prevention
This photo shows a severe case of dermatitis herpetiformis in a 4-year-old child.
Dermatitis herpetiformis most often starts between the ages of 30 and 40, though people of any age can be affected.The condition had long been considered rare in children under 10, but more cases have been identified in recent years.
Most cases arechronic(persistent or recurrent), with the frequency of outbreaks varying from one person to the next. In the majority of cases, the outbreaks will occur on the same part of the body every time.
Dermatitis Herpetiformis on the Lower Limbs
BallenaBlanca / Creative Commons
Because of its appearance and itchiness, a dermatitis herpetiformis rash is often mistaken for other skin conditions, such as:
One of the things that differentiates dermatitis herpetiformis from similar skin conditions is that the rash typically develops symmetrically.
Allergic contact dermatitis, irritant contact dermatitis, and shingles all develop asymmetrically, while eczema, psoriasis, and scabies can either be symmetrical or asymmetrical.
Dermatitis Herpetiformis on the AbdomenDermnet / Creative CommonsThis photo shows a dermatitis herpetiformis outbreak on the abdomen. Note the symmetrical presentation of the rash.Dermatitis herpetiformis isn’t the only skin condition linked to celiac disease. Eczema—a condition common in children but also seen in adults—may be associated with both celiac disease andnon-celiac gluten sensitivity.Psoriasis—common starting between the ages of 20 and 30 or later between the ages of 50 and 60—also shares a strong link with celiac and gluten sensitivity.However, dermatitis herpetiformis has the strongest link to celiac disease of any skin condition. All told, between 15% to 25% of people with celiac disease also have dermatitis herpetiformis.If you’ve been diagnosed with dermatitis herpetiformis, you almost certainly have celiac disease.
Dermatitis Herpetiformis on the Abdomen
Dermnet / Creative Commons
This photo shows a dermatitis herpetiformis outbreak on the abdomen. Note the symmetrical presentation of the rash.
Dermatitis herpetiformis isn’t the only skin condition linked to celiac disease. Eczema—a condition common in children but also seen in adults—may be associated with both celiac disease andnon-celiac gluten sensitivity.
Psoriasis—common starting between the ages of 20 and 30 or later between the ages of 50 and 60—also shares a strong link with celiac and gluten sensitivity.
However, dermatitis herpetiformis has the strongest link to celiac disease of any skin condition. All told, between 15% to 25% of people with celiac disease also have dermatitis herpetiformis.
If you’ve been diagnosed with dermatitis herpetiformis, you almost certainly have celiac disease.
Dermatitis Herpetiformis on the HandsBallenaBlanca / Creative CommonsIt’s somewhat unusual to see dermatitis herpetiformis on the hands, but the rash can ultimately occur anywhere on the body.Dermatitis herpetiformis is more common in males, unlike celiac disease which isdiagnosed more often in females. In fact, some studies suggest that males are twice as likely to have dermatitis herpetiformis than females.There has been relatively little research done on the health risks associated with dermatitis herpetiformis. Some studies show an increased risk ofosteopenia(thinning bones) in nearly two of every five people with dermatitis herpetiformis.Other studies have reported an increased risk for thyroid disease—not surprising given thatceliac disease and autoimmune thyroid disease(likeHashimoto’s thyroiditisorGraves disease) are often diagnosed together.
Dermatitis Herpetiformis on the Hands
It’s somewhat unusual to see dermatitis herpetiformis on the hands, but the rash can ultimately occur anywhere on the body.
Dermatitis herpetiformis is more common in males, unlike celiac disease which isdiagnosed more often in females. In fact, some studies suggest that males are twice as likely to have dermatitis herpetiformis than females.
There has been relatively little research done on the health risks associated with dermatitis herpetiformis. Some studies show an increased risk ofosteopenia(thinning bones) in nearly two of every five people with dermatitis herpetiformis.
Other studies have reported an increased risk for thyroid disease—not surprising given thatceliac disease and autoimmune thyroid disease(likeHashimoto’s thyroiditisorGraves disease) are often diagnosed together.
How Dermatitis Herpetiformis Is Diagnosed
Dermatitis herpetiformis is diagnosed with a combination of a blood test andskin biopsy.
The blood test looks for immune proteins, calledimmunoglobulin A (IgA) antibodiesthat are closely associated with dermatitis herpetiformis.
With the biopsy, a small sample of skin is removed for evaluation in the lab. If you have dermatitis herpetiformis, the sample will show deposits of IgA between the top and middle layers of skin (called theepidermisanddermis) when examined under a microscope.
Skin Biopsy for Dermatitis Herpetiformis: What to Expect
How Dermatitis Herpetiformis Is Treated
Currently, the only long-term treatment for dermatitis herpetiformis is agluten-free diet.
The oralantibioticdapsone may be prescribed for the short-term relief of symptoms, but it can cause significant side effects in some people, including nausea, vomiting, dizziness, blurred vision, insomnia, lightheadedness, fatigue, andtinnitus(ringing in the ears).
For this reason, dapsone is used sparingly to help bring the rash under control.
Summary
Dermatitis herpetiformis is an autoimmune skin condition linked to celiac disease that causes an intensely itchy rash with tiny fluid-filled blisters. Between 15% and 25% of people with celiac disease have dermatitis herpetiformis.
The rash usually affects areas of skin on the outside of a joint (such as the knees or elbows) on both sides of the body, The condition can come or go but tends to affect the same body part each time. Severe cases can cause scarring and ongoing redness.
The most effective treatment for dermatitis herpetiformis is a gluten-free diet, though the oral antibiotic dapsone may help resolve the rash and relieve itching and discomfort.
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10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol. 2015;8:257-65. doi:10.2147/CCID.S69127Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC.Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.An Bras Dermatol. 2014;89(6):865-75. doi:10.1590/abd1806-4841.20142966Czaja-Bulsa G.Non coeliac gluten sensitivity - a new disease with gluten intolerance.Clin Nutr. 2015;34(2):189-94. doi:10.1016/j.clnu.2014.08.012Nguyen CN, Kim SJ.Dermatitis herpetiformis: an update on diagnosis, disease monitoring, and management.Medicina (Kaunas).2021 Aug;57(8):843. doi:10.3390/medicina57080843Salmi T, Hervonene K.Current concepts of dermatitis herpetiformis.Acta Derm Venereo.2020 Feb 12;100(5):adv00056. doi:10.2340/00015555-3401Bonciolini V, Bianchi B, Del Bianco E, Verdelli A. Caproni M.Cutaneous manifestations of non-celiac gluten sensitivity: clinical histological and immunopathological features.Nutrients.2015 Sep;7(9):7798–7805. doi:10.3390/nu7095368Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P.Dermatitis herpetiformis: a common extraintestinal manifestation of coeliac disease.Nutrients. 2018;10(5) doi:10.3390/nu10050602Lheure C, Ingen-Housz-Oro S, Guignard S, et al.Dermatitis herpetiformis and bone mineral density: analysis of a French cohort of 53 patients.Eur J Dermatol. 2017 Aug 1;27(4):353-358. doi:10.1684/ejd.2017.3029Ashok T, Patni N, Garima M, Lamis A, Siddiqui SW.Celiac disease and autoimmune thyroid disease: the two peas in a pod.Cureus.2022 Jun;14(6):e26243. doi:10.7759/cureus.26243Celiac Disease Foundation.Dermatitis Herpetiformis.Additional ReadingAmerican Osteopathic College of Dermatology.Dermatitis herpetiformis.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol. 2015;8:257-65. doi:10.2147/CCID.S69127Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC.Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.An Bras Dermatol. 2014;89(6):865-75. doi:10.1590/abd1806-4841.20142966Czaja-Bulsa G.Non coeliac gluten sensitivity - a new disease with gluten intolerance.Clin Nutr. 2015;34(2):189-94. doi:10.1016/j.clnu.2014.08.012Nguyen CN, Kim SJ.Dermatitis herpetiformis: an update on diagnosis, disease monitoring, and management.Medicina (Kaunas).2021 Aug;57(8):843. doi:10.3390/medicina57080843Salmi T, Hervonene K.Current concepts of dermatitis herpetiformis.Acta Derm Venereo.2020 Feb 12;100(5):adv00056. doi:10.2340/00015555-3401Bonciolini V, Bianchi B, Del Bianco E, Verdelli A. Caproni M.Cutaneous manifestations of non-celiac gluten sensitivity: clinical histological and immunopathological features.Nutrients.2015 Sep;7(9):7798–7805. doi:10.3390/nu7095368Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P.Dermatitis herpetiformis: a common extraintestinal manifestation of coeliac disease.Nutrients. 2018;10(5) doi:10.3390/nu10050602Lheure C, Ingen-Housz-Oro S, Guignard S, et al.Dermatitis herpetiformis and bone mineral density: analysis of a French cohort of 53 patients.Eur J Dermatol. 2017 Aug 1;27(4):353-358. doi:10.1684/ejd.2017.3029Ashok T, Patni N, Garima M, Lamis A, Siddiqui SW.Celiac disease and autoimmune thyroid disease: the two peas in a pod.Cureus.2022 Jun;14(6):e26243. doi:10.7759/cureus.26243Celiac Disease Foundation.Dermatitis Herpetiformis.Additional ReadingAmerican Osteopathic College of Dermatology.Dermatitis herpetiformis.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol. 2015;8:257-65. doi:10.2147/CCID.S69127Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC.Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.An Bras Dermatol. 2014;89(6):865-75. doi:10.1590/abd1806-4841.20142966Czaja-Bulsa G.Non coeliac gluten sensitivity - a new disease with gluten intolerance.Clin Nutr. 2015;34(2):189-94. doi:10.1016/j.clnu.2014.08.012Nguyen CN, Kim SJ.Dermatitis herpetiformis: an update on diagnosis, disease monitoring, and management.Medicina (Kaunas).2021 Aug;57(8):843. doi:10.3390/medicina57080843Salmi T, Hervonene K.Current concepts of dermatitis herpetiformis.Acta Derm Venereo.2020 Feb 12;100(5):adv00056. doi:10.2340/00015555-3401Bonciolini V, Bianchi B, Del Bianco E, Verdelli A. Caproni M.Cutaneous manifestations of non-celiac gluten sensitivity: clinical histological and immunopathological features.Nutrients.2015 Sep;7(9):7798–7805. doi:10.3390/nu7095368Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P.Dermatitis herpetiformis: a common extraintestinal manifestation of coeliac disease.Nutrients. 2018;10(5) doi:10.3390/nu10050602Lheure C, Ingen-Housz-Oro S, Guignard S, et al.Dermatitis herpetiformis and bone mineral density: analysis of a French cohort of 53 patients.Eur J Dermatol. 2017 Aug 1;27(4):353-358. doi:10.1684/ejd.2017.3029Ashok T, Patni N, Garima M, Lamis A, Siddiqui SW.Celiac disease and autoimmune thyroid disease: the two peas in a pod.Cureus.2022 Jun;14(6):e26243. doi:10.7759/cureus.26243Celiac Disease Foundation.Dermatitis Herpetiformis.
Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol. 2015;8:257-65. doi:10.2147/CCID.S69127
Clarindo MV, Possebon AT, Soligo EM, Uyeda H, Ruaro RT, Empinotti JC.Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment.An Bras Dermatol. 2014;89(6):865-75. doi:10.1590/abd1806-4841.20142966
Czaja-Bulsa G.Non coeliac gluten sensitivity - a new disease with gluten intolerance.Clin Nutr. 2015;34(2):189-94. doi:10.1016/j.clnu.2014.08.012
Nguyen CN, Kim SJ.Dermatitis herpetiformis: an update on diagnosis, disease monitoring, and management.Medicina (Kaunas).2021 Aug;57(8):843. doi:10.3390/medicina57080843
Salmi T, Hervonene K.Current concepts of dermatitis herpetiformis.Acta Derm Venereo.2020 Feb 12;100(5):adv00056. doi:10.2340/00015555-3401
Bonciolini V, Bianchi B, Del Bianco E, Verdelli A. Caproni M.Cutaneous manifestations of non-celiac gluten sensitivity: clinical histological and immunopathological features.Nutrients.2015 Sep;7(9):7798–7805. doi:10.3390/nu7095368
Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P.Dermatitis herpetiformis: a common extraintestinal manifestation of coeliac disease.Nutrients. 2018;10(5) doi:10.3390/nu10050602
Lheure C, Ingen-Housz-Oro S, Guignard S, et al.Dermatitis herpetiformis and bone mineral density: analysis of a French cohort of 53 patients.Eur J Dermatol. 2017 Aug 1;27(4):353-358. doi:10.1684/ejd.2017.3029
Ashok T, Patni N, Garima M, Lamis A, Siddiqui SW.Celiac disease and autoimmune thyroid disease: the two peas in a pod.Cureus.2022 Jun;14(6):e26243. doi:10.7759/cureus.26243
Celiac Disease Foundation.Dermatitis Herpetiformis.
American Osteopathic College of Dermatology.Dermatitis herpetiformis.
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