Dermatitis herpetiformis or DH is a condition associated with celiac disease that affects the skin. When someone with DH ingests gluten, an autoimmune response occurs in the skin causing intensely itchy blisters to form, usually on the elbows, knees, or buttocks. The back, abdomen, face and scalp may also be affected, but are not as common (1). People with DH may or may not have villous atrophy in the intestine, but the majority do (2).

Studies have shown that about 1 in 8 people with celiac disease has DH. Interestingly, the yearly incidence of DH is decreasing while the incidence of celiac disease is increasing (1). This is thought to be due to the increased diagnosis of subclinical celiac disease (3).

How is DH diagnosed?

DH is usually diagnosed by a skin biopsy with immunofluorescence, performed by a dermatologist. A positive test will have IgA deposits in the papillary dermis (1). People with a positive test should also be evaluated for celiac disease.

What is the treatment for DH?

The treatment for DH is a strict gluten-free diet. Medications such as dapsone can also be used to control symptoms in conjunction with the diet, especially in the beginning. The medication can usually be tapered off after strict adherence to the gluten-free diet as symptoms are resolving. Like with celiac disease, DH is permanent and requires a lifelong gluten-free diet. The good news is that the long-term prognosis for those following a gluten-free diet is excellent, and the mortality rate is found to be lower than the general population (1,3).

Do I need gluten-free skincare products if I have DH?

Like with celiac disease, gluten needs to be ingested to cause an autoimmune reaction in DH. It is optional but not required for people with DH or celiac disease to use gluten-free skincare/cosmetics as gluten cannot penetrate the skin. We recommend skincare products to be gluten-free if there is a potential that they might be ingested, or if you have allergic skin reactions to gluten. 

Here is what celiac disease specialist Alessio Fasano says about skincare and celiac disease/DH:

 “There is currently no scientific evidence that gluten used in cosmetics that are not ingested is harmful to individuals with celiac disease, including those with dermatitis herpetiformis (the skin form of celiac disease). If you have celiac disease, then the application of gluten-containing products to the skin should not be a problem, unless you have skin lesions that allow gluten to be absorbed systemically in great quantities. The reason why this should not be a problem is that, based on what we know right now, it is the oral ingestion of gluten that activates the immunological cascades leading to the autoimmune process typical of celiac disease.” (4)

Read more here about skincare and celiac disease.

Confused about the different gluten-related disorders? Check out this infographic:

References:

1. Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P. Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease. Nutrients. 2018 May 12;10(5):602. doi: 10.3390/nu10050602. PMID: 29757210; PMCID: PMC5986482
2. Mansikka E, Hervonen K, Kaukinen K, et al. Prognosis of Dermatitis Herpetiformis Patients with and without Villous Atrophy at Diagnosis. Nutrients. 2018;10(5):641. Published 2018 May 19. doi:10.3390/nu10050641
3. Reunala T, Salmi TT, Hervonen K. Dermatitis herpetiformis: pathognomonic transglutaminase IgA deposits in the skin and excellent prognosis on a gluten-free diet. Acta Derm Venereol. 2015 Nov;95(8):917-22. doi: 10.2340/00015555-2162. PMID: 26059085.
4. Thompson T, Grace T. Gluten in cosmetics: is there a reason for concern? J Acad Nutr Diet. 2012 Sep;112(9):1316-23.

Reviewed October 21, 2022.