The effects of celiac disease reach far beyond internal digestive symptoms to a skin condition sometimes referred to as celiac rash. The name is a reflection of the link between dermatitis herpetiformis (DH) and gluten intolerance. The presence of this celiac rash condition underscores the psychological effects of celiac disease.
What Is Dermatitis Herpetiformis?
DH is a disorder which causes intense itching and prominent skin eruptions. It most commonly attacks the elbows, knees, and scalp. According to the American Osteopathic College of Dermatology, it is most likely to occur in young adult men or those of northern European descent.
Sufferers may experience burning or stinging sensations. Small water blisters are visible as well. Scabs eventually form, and the spots heal. However, once it occurs, the majority of victims will have this celiac rash condition for life.
Immune System Response
The effects of DH are triggered by IgA anti-gliadin antibodies, the same antibody which attacks the villi of the small intestine. Their presence indicates an immune system response. In this case, the immune system response occurs in the bloodstream where gluten combines with the antibody.
The presence of these larger molecules of gluten and IgA can impair blood flow in the smaller blood vessels. This action initiates the immune response by the white blood cells, causing the blisters to form. The reaction to gluten gives the condition its moniker, celiac rash.
While the disease is typically associated with celiac disease, it also has been reported in patients with systemic lupus erythematosus, as explained by a 2010 study in the Journal of the American Academy of Dermatology (63(5):892-895).
While some people have both celiac disease and DH, not everyone who has celiac disease will come down with this skin condition as well. Others may only have DH and not celiac disease. The biology around these different scenarios is not fully understood.
The intense itching may lead to secondary infections due to scratching of the skin eruptions. Excessive scratching may also lead to scarring.
Because the rash is visible, people with DH also have to cope with the psychological effects of yet another condition which makes them feel different from everyone else. It is especially unfortunate that teen-aged boys may develop DH at a vulnerable time in their lives.
A 2010 study in the journal, Digestion (82(4):221-228), found that at the time of diagnosis, patients tended to perceive they had a lower health-related quality of life. Having a condition such as celiac rash certainly would not help that perception, making treatment essential both for physical and psychological well-being.
Treatment of Celiac Rash
Like celiac disease, you will have to treat DH your entire life. Fortunately, there are two courses of treatment, both of which are highly effective. As a 2010 study in the French journal, Presse Médicale ((10):1042-1048) explains, a gluten-free diet is the treatment of choice.
If you are already following this diet, you will remove the two triggers needed for the disease to manifest itself: gluten and the IgA antibody. This lifestyle change is preferable to medical treatment which though effective, has serious side effects and possible complications.
Those who have celiac rash but do not have gastrointestinal issues with gluten may begin a treatment course using a drug called dapsone. Dapsone is an oral medication taken once daily. Your doctor will work closely with you to dose dapsone at the lowest level needed for control.
Dapsone can cause serious side effects. Some individuals may experience abdominal pain or muscle weakness. Other effects involve possible blood or liver problems, advises the Drugsite Trust. These may include a bluish skin color, yellowing of eyes or skin, or dark-colored urine.
Less serious side effects include headache, ringing in the ears, and increased sensitivity of the skin to sunlight. People taking dapsone for DH should avoid prolonged, unprotected exposure to UV radiation.
Celiac rash is another concern for those with celiac disease or gluten sensitivity. Fortunately, treatment options including lifestyle changes can help you cope with troubling skin condition. It is yet another reason to embrace a gluten-free lifestyle.