Celiac Disease Rash: Overview, Symptoms and Treatment

Photo by Orrling and Tomer S, CC BY-SA 3.0, via Wikimedia Commons

OVERVIEW

Celiac disease rash is a skin condition linked to celiac disease. Its medical name is "dermatitis herpetiformis" (DH). The rash causes intensely itchy bumps and small blisters that appear in clusters. The most affected sites are elbows and knees, along with the buttocks.

People with DH often feel an intense, hard-to-resist urge to scratch.

What Is Celiac Disease Rash?

DH is a skin form of celiac disease. It is caused by the same immune reaction to gluten, a protein found in wheat, barley and rye. Nuts do not contain gluten.

In people with DH, the immune system makes IgA antibodies in response to gluten. These antibodies collect in the skin and trigger inflammation, which causes the rash.

What Is Age For Development Of Celiac Disease?

Celiac disease rash can affect any age group, but it is mostly a disease of adults. A review of dermatitis herpetiformis reports an average age at diagnosis of 40 to 50 years. It is uncommon in children.

The rash improves on a strict gluten-free diet and tends to come back if gluten is eaten again. Without treatment, it often comes and goes in flares.

Where Does Celiac Disease Occur?

The rash usually appears on the elbows, knees and buttocks, and it can also affect the back and scalp.

It is one of the itchiest skin conditions. It can look like other itchy skin problems, but the itch is often severe, and some people feel burning or stinging before new spots appear.

• Celiac Disease Rash on abdomen:

The rash is typically symmetrical, meaning it tends to appear on both sides of the body in the same areas. The abdomen is a less common site than the elbows, knees and buttocks.

• Celiac Disease Rash on legs and feet:

On the legs, the rash usually appears on both knees and nearby skin, and the person feels itching over the affected areas.

• Celiac Disease Rash on hands:

The hands are usually spared, though the rash can occasionally appear there. When it does, small itchy, fluid-filled blisters may cause burning and itching.

Who Develops Celiac Rash?

• According to the NIDDK, about 10% to 20% of adults and 2% to 3% of children with untreated celiac disease have DH
• It affects slightly more males than females, unlike celiac disease, which is more common in females
• It most often starts in adulthood
• it is not common in childhood
• Most people with DH have no obvious digestive symptoms, even though most have some intestinal damage from celiac disease

SIGNS AND SYMPTOMS

The rash of celiac disease consists of small, very itchy red bumps and blisters. They appear in clusters, and scratching often breaks them open, leaving small scabs and erosions.

Some people feel burning or stinging in the area before new bumps appear. After the rash heals, the skin may be left with lighter or darker marks for a while.

HOW TO DIAGNOSE?

The rash of the dermatitis herpetiformis may be confused with eczema, simple acne, hives, scabies, or any bug bite so apart from clinical diagnosis alone, Laboratory diagnosis is also required for the confirmation of the disease.

• Skin biopsy: A doctor removes a small sample of normal-looking skin right next to the rash. A test called direct immunofluorescence looks for granular IgA deposits in the top layer of the dermis (the dermal papillae). This is the key test to confirm DH.
• Blood tests: Antibody tests for celiac disease, such as tissue transglutaminase IgA (tTG-IgA), are often positive in people with DH and support the diagnosis.

TREATMENT

1- Gluten-Free Diet:

There is no cure for DH, but it can be controlled. A strict, lifelong gluten-free diet is the main treatment. You can eat rice, but not wheat, barley or rye. Oats are allowed only if labeled gluten-free.

The skin responds slowly. The NIDDK says the rash may not go away until a person has followed a gluten-free diet for 6 months to 2 years. Digestive symptoms, if present, usually improve much faster.

2- Medications:

• Dapsone: DAPSONE is a prescription medicine taken by mouth. It relieves the itch and rash within a few days, but it does not treat the intestinal damage. It can have side effects, including on the blood, so it requires regular blood tests. Doctors usually taper it off once the gluten-free diet controls the rash, often after about 2 years.
• Corticosteroids: A doctor may suggest a steroid cream to help reduce itching and inflammation for a short time.

For How Long the Rash Last?

The rash can take months to years to clear completely on a gluten-free diet alone. Dapsone controls it faster while the diet takes effect.

When to Seek Medical Help?

DH is a chronic condition. See a doctor or dermatologist if you have an itchy, blistering rash that keeps coming back, especially on the elbows, knees or buttocks. Don't start a gluten-free diet before you're tested, because it can affect the results.

HP Thoughts: Be informed on how to treat celiac disease! Continue reading our series on this ailment: Celiac Disease Treatment.

Sources

• Dermatitis Herpetiformis: An Update on Diagnosis and Management, American Journal of Clinical Dermatology (Reunala et al., 2021)
• Symptoms & Causes of Celiac Disease, NIDDK
• Treatment for Celiac Disease, NIDDK