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. Up to 1 in 10 people who have coeliac disease have dermatitis herpetiformis.

It is also known as Duhring’s disease and Duhring–Brocq disease.

What are the symptoms of dermatitis herpetiformis?

Dermatitis herpetiformis causes a bumpy skin rash with groups of tiny blisters. The rash can be very itchy. You might feel itching or burning before the rash appears.

The rash usually appears on:

• your elbows
• your knees
• your buttocks
• your shoulder blades

The rash can come and go over time. Sometimes it leaves pale or darker patches of skin. It is not contagious (you can’t catch it).

Other symptoms you may have are:

• fluid-filled sores
• red sores that look like hives
• itchiness
• redness and burning

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 produces 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 can be associated with other immune conditions, like thyroid disease, Type 1 diabetes and lupus.

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?

If your doctor suspects you have dermatitis herpetiformis, they will refer you to a dermatologist (a skin specialist). The condition can look like:

• eczema
• scabies

The dermatologist will:

• examine you
• recommend a skin biopsy

They may also do a blood test. This is to look for markers of coeliac disease.

You may also be referred to a gastroenterologist (a doctor who specialises in looking after the digestive system). They can investigate whether you have coeliac disease. They may do further tests, like an endoscopy.

How is dermatitis herpetiformis treated?

You can manage dermatitis herpetiformis with a gluten-free diet. Sometimes this is the only treatment needed.

It may take 6 to 24 months for your rash to disappear after removing gluten from your diet.

You may be given dapsone during this time to improve your rash symptoms. Dapsone is an antibiotic. You might need medicines for a year or 2. Your doctor will check your health while you’re taking this medicine.

You may also be given steroid creams to soothe the skin inflammation.

Although diet and medicines can treat your symptoms, dermatitis herpetiformis will not go away. If you have the condition, you will need to remove gluten from your diet for life.

Can dermatitis herpetiformis be prevented?

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

Complications of dermatitis herpetiformis

Up to 3 in 4 patients with dermatitis herpetiformis have damage to their small intestine.

You can help stop complications by avoiding foods that have gluten in them. Sticking to a gluten-free diet can lower the amount of medicine you need to control the disease.

Resources and support

You can find out more from Coeliac Australia's website at www.coeliac.org.au.

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