Ask The Gluten Free RD: What is Dermatitits Herpetiformis (DH) | Rachel Begun, MS, RD

I have been asked many times what is Dermatitis Herpetiformis (DH), even by people with celiac disease.

Here is the official definition per The Oslo Definitions (recently, an international task force of physicians came together to find consensus on terms for celiac disease and other gluten related disorders):

DH is a cutaneous manifestation of small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten. It is characterised by herpetiform clusters of pruritic urticated papules and vesicles on the skin, especially on the elbows, buttocks and knees, and IgA deposits in the dermal papillae.  DH responds to a GFD (gluten free diet).

In more simple terms, DH is a form of celiac disease characterized by a chronic skin condition of a burning, itching rash.  The rash exists symmetrically on the body, usually on the elbows, knees and buttocks, but can also occur on other parts of the body.  People with DH present with varying degrees of intestinal damage, but may not experience GI symptoms.

Diagnosis of DH is determined by a skin biopsy. An intestinal biopsy is not necessary if the skin biopsy shows positive for DH.

As is the case with “typical” celiac disease, people with DH must follow a 100% gluten free diet.  Drugs can be taken to improve rash symptoms, but a strict gluten free diet must still be followed to prevent the immune response and subsequent intestinal damage.

Image courtesy of: Wikimedia Commons, author: madhero88

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