What is dermatitis herpetiformis?

Dermatitis herpetiformis is a skin condition that causes an itchy, bumpy skin rash. It can be a symptom of coeliac disease.

About 1 in 5 people who have coeliac disease have dermatitis herpetiformis. It's also known as 'Duhring's disease' and 'Duhring-Brocq disease'.

What are the symptoms of dermatitis herpetiformis?

Dermatitis herpetiformis causes an itchy, bumpy skin rash. There can be tiny blisters. You might feel itching or burning before the rash appears.

The rash usually appears on your:

• elbows
• knees
• buttocks
• shoulder blades

The rash is symmetrical (meaning it affects both sides of your body). It can sometimes look like eczema or scabies. It's not contagious (you can't catch it).

The rash may leave pale or darker patches of skin. This is more common in people with darker skin.

What causes dermatitis herpetiformis?

Most people with dermatitis herpetiformis have coeliac disease. Coeliac disease is an autoimmune condition.

The rash appears when you eat gluten. It's caused when your immune system reacts to gluten.

Your immune system makes antibodies to attack the gluten proteins. These antibodies then travel through your bloodstream and build up under your skin, causing the rash.

Sometimes, dermatitis herpetiformis is linked to other immune conditions, like:

• Addison's disease
• thyroid disease
• type 1 diabetes
• vitiligo

When should I see my doctor?

If you think you might have dermatitis herpetiformis, you should see your doctor.

Dermatitis herpetiformis might be a sign that you have coeliac disease or another health condition. Being aware of your condition will help you get the right treatment.

How is dermatitis herpetiformis diagnosed?

Your doctor will ask you about your symptoms and examine you. They may suggest that you have:

• a skin biopsy
• blood tests — to look for markers of coeliac disease

Your doctor may refer you to a:

• dermatologist (skin specialist)
• gastroenterologist (doctor who specialises in looking after the digestive system)

A gastroenterologist can do an endoscopy to see if you have coeliac disease.

How is dermatitis herpetiformis treated?

Dermatitis herpetiformis is managed with a gluten-free diet. This might be the only treatment you need.

A gluten-free diet means removing certain foods from your diet. These include:

• wheat
• rye
• barley
• triticale
• khorasan wheat (kamut^®)
• spelt

These grains are often found in:

• bread
• pasta
• baked goods
• drinks made from grains, such as beer

Oats can easily be contaminated by gluten from other grains.

Your doctor may suggest that you see a dietitian for guidance on keeping to a gluten-free diet.

It may take up to 2 years for a gluten-free diet to work well.

Medicines for dermatitis herpetiformis

Your doctor may give you dapsone to improve your itch. Dapsone is an antibiotic.

Your doctor will check your health regularly while you take this medicine.

Once the gluten-free diet starts working, your doctor will start to reduce your dose of dapsone.

Your doctor may also prescribe steroid creams to soothe your skin.

Living with dermatitis herpetiformis

Although a gluten-free diet will treat your symptoms, dermatitis herpetiformis does not go away.

You will need to keep removing gluten from your diet for the rest of your life.

What are the complications of dermatitis herpetiformis?

Lymphoma is related to dermatitis herpetiformis, in the first 5 years after diagnosis.

Can dermatitis herpetiformis be prevented?

There is no known way to prevent dermatitis herpetiformis. However, you can often stop dermatitis herpetiformis returning by keeping to a strict, gluten-free diet.

Resources and support

You can find out more about dermatitis herpetiformis at Coeliac Australia.

The Dietitians Australia website allows you to search for an Accredited Practising Dietitian.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.