An itchy, blistering, burning skin rash, dermatitis herpetiformis (DH) is a difficult condition to live with. The rash and itching occur on the elbows, knees, scalp, back, and buttocks. This rash likely indicates gluten intolerance, which may be related to a more serious underlying condition known as celiac disease. DH is sometimes called Duhring’s disease or gluten rash. People who have this condition need to maintain a strict gluten-free diet.

Causes of Dermatitis Herpetiformis
From the sound of the name, many people think this rash is caused by some form of the herpes virus. This isn’t the case, as it has nothing to do with herpes. Dermatitis herpetiformis occurs in people with celiac disease. Celiac disease (also called celiac sprue, gluten intolerance, or gluten-sensitive enteropathy) is an autoimmune disorder characterized by intolerance to gluten. Gluten is a protein found in wheat, rye, and barley. It’s also sometimes found in oats that have been processed in plants that handle other grains.

Treatment of Dermatitis Herpetiformis
The sulfone dapsone can provide immediate relief of symptoms. For patients who cannot tolerate dapsone, sulfapyridine or sulfamethoxypyridazine may be used, although these medications are less effective than dapsone. A strict gluten-free diet is the only treatment for the underlying disease. Even with a gluten-free diet, medication therapy may need to be continued from a few months to 2 years.

DH can go into remission, which is defined as absence of skin lesions and symptoms of DH for more than 2 years while not taking sulfones or other treatments and not adhering to a gluten-free diet. Cohort studies showing DH remission provide support for reducing sulfone therapy and weaning from a gluten-free diet in patients with well-controlled DH.