Dermatitis Herpetiformis


Dermatitis herpetiformis is an uncommon itchy skin condition which can occur at any age. It is a specific skin change seen in coeliac disease. Most people with dermatitis herpetiformis also have the more common bowel problems associated with coeliac disease known as gluten enteropathy. If the bowel is involved, individuals often have symptoms such as bloating, cramping or diarrhoea.

Dermatitis herpetiformis on the knees – image reproduced with permission of Dr Davin Lim

Most people with dermatitis herpetiformis have coeliac disease which is an autoimmune condition causing gluten intolerance. The body’s immune system reacts against a certain component of gluten in the diet, causing inflammation of the skin.

Itchy pink-red bumps or tiny blisters appear often symmetrically on the outer aspects of elbows, knees, buttocks, scalp or shoulders. The blisters may not be obvious to see, as they are often scratched off. Dermatitis herpetiformis can be mistaken for eczema or scabies.

Image reproduced with permission of Dr Davin Lim
Image reproduced with permission of Dr Davin Lim


A skin biopsy is needed to confirm the diagnosis. Blood tests are often performed to identify specific autoimmune markers for coeliac disease. Sometimes individuals may be referred to a gastroenterologist for further tests such as an endoscopy, where a biopsy of the small bowel is taken.

A skin biopsy is needed to confirm the diagnosis. Even with a skin biopsy, it can be difficult to distinguish between benign cases and lymphoma-associated cases.

Once follicular mucinosis is diagnosed, further assessments are needed to exclude the possibility of an underlying lymphoma. This may include a physical examination, blood tests and imaging studies. Ongoing follow-up is also recommended.

A strict gluten-free diet is strongly advised. This may be the only treatment that is required. There are many online resources available listing foods which contain gluten. Formal advice from a dietician can also be provided.

Other treatments include the medication dapsone, though this requires regular blood test monitoring. Cortisone-based anti-inflammatory creams can be used but are only temporarily soothing.

This information has been written by Dr Anita Lasocki


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