Dermatitis Herpetiformis
Dermatitis herpetiformis (DH, Duhring’s disease) bumps and blisters resemble herpes lesions, hence the name "herpetiformis," but are NOT caused by the herpes virus. They are caused by gluten ingestion. While people with DH are at the same risk for the complications suffered by people with celiac disease, as many as 20% of people with DH will have a normal intestinal biopsy. However, DH patients with a normal intestinal biopsy and normal celiac serology (blood test) will still respond to a gluten-free diet. Symptoms tend to come and go, and DH is commonly diagnosed as eczema. Symptoms normally resolve with a strict, gluten-free diet.

DH affects 10-15% of people with celiac disease. DH patients frequently have no digestive symptoms. DH can affect people of all ages, but most often appears for the first time in those between the ages of 30 and 40. People of northern European descent are more likely than those of African or Asian heritage to develop DH. The condition is somewhat more common in men than women, and men are more likely to have atypical oral or genital lesions.

How does a disorder that damages the intestines show up on the skin? "When a person with celiac disease consumes gluten, the mucosal immune system in the intestine responds by producing a type of antibody called immunoglobulin A (IgA)," explains John Zone, MD, CDF Medical Advisory Board Member and Chairman of the Department of Dermatology at the University of Utah School of Medicine. These IgA antibodies are directed against epidermal transglutaminase. The antibodies then travel to the skin where they bind with the epidermal transglutaminase protein. Gluten ingestion seems to trigger this reaction.