Herpetiformis Dermatitis: Causes, Symptoms, Diagnosis, Treatment, Complications and Prognosis

Known by its acronym as (DH), it is an itchy rash that is common in people with celiac disease.

It is an autoimmune disorder that prevents your body from digesting gluten , a protein found in wheat and other grains.

Also known as Duhring’s disease, it causes blisters that look like herpes, but the condition does not come from the herpes virus. It is related to gluten allergies.

Causes of dermatitis herpetiformis

If the person has celiac disease and eats gluten, their intestines produce an antibody called IgA in response.

This chemical flows into the bloodstream and collects in the blood vessels under the skin. Activates the DH rash.

This condition is rare in children. It usually first appears when you are in your 30s and 40s.
Men tend to have it more often than women. It is most common in people of European descent and rare among African Americans and Asian Americans.


The first thing you will probably notice is a burning or stinging sensation in certain places on your skin.
After that, clusters of small, red bumps emerge. They are very itchy and can take various forms, such as:

  • Blisters
  • Fluid-filled sores
  • Sores that look like hives.
  • Raised sores

You may mistake your bumps and blisters for eczema. Most often, dermatitis herpetiformis appears in:

  • Elbows or knees
  • Scalp.
  • Back.
  • You can also get them in other places on your body, such as your neck, face, or groin.

They generally appear on both sides of your body at the same time. Sometimes dermatitis herpetiformis can even affect tooth enamel.

Blisters take one to two weeks to heal and heal, but new blisters often grow in their place.
Symptoms can go away and come back over time. Once you get dermatitis herpetiformis, you usually face it for the rest of your life.

Diagnosis of dermatitis herpetiformis

Your doctor will need to do a skin biopsy. After numbing the area, you will use a very small instrument that works like a cookie cutter to “pierce” part of the skin.

You may need a point or two to close the site. It should heal quickly, with very little scarring.

A lab will use dye to see if you have IgA in a certain type of pattern. This tells your doctor if you have DH. He may also take some of your blood to test for celiac disease.


Dermatitis herpetiformis can be treated with an antibiotic called dapsone.

Dapsone is a powerful medicine with serious side effects. The dose must be slowly increased over several months before it is fully effective.

Most people feel relief from taking dapsone, but side effects can include:

  • Liver problems
  • Sensitivity to sunlight.
  • Anemia.
  • Muscular weakness.
  • Peripheral neuropathy.

Dapsone can also have negative interactions with other medications, such as potassium aminobenzoate, clofazimine, or trimethoprim.

Other medications that may be used include tetracycline, sulfapyridine, and some immunosuppressive medications. These are less effective than dapsone.

The most effective treatment without side effects is strict adherence to a gluten-free diet.
This means that you should completely avoid foods, drinks, or medicines that contain the following:

  • Rye wheat
  • Barley.
  • Avena.

Although this diet can be difficult to follow, it will have the most beneficial effect on your health if you have celiac disease, as any reduction in your gluten intake can help decrease the amount of medication you will need to take.

What are the complications of dermatitis herpetiformis?

People with DH and untreated celiac disease may have an increased risk of intestinal cancer due to the constant inflammation in the intestines.

Vitamin deficiencies and anemia can also be a problem if the intestines are not absorbing nutrients properly.

Since dermatitis herpetiformis is an autoimmune disease, the researchers found that it is also associated with other types of autoimmune diseases. These include:

What is the long-term outlook for dermatitis herpetiformis?

Dermatitis herpetiformis is a lifelong disease. You can go into remission, but every time you are exposed to gluten, you can have a rash flare-up.

Without treatment, DH and celiac disease can cause many negative health effects, including vitamin deficiencies, anemia, and gastrointestinal cancer.

Dapsone treatment can control the symptoms of the rash fairly quickly. However, intestinal damage caused by celiac disease can only be treated by maintaining a strict gluten-free diet.

Be sure to discuss any specific dietary considerations with your doctor or nutritionist.