Dr. M.J. Bazos, MD
Dermatitis herpetiformis is a
chronic, recurrent skin disorder characterized by clusters of itchy, small
vesicles (blisters) and papules (red bumps). The specific cause is unknown. It
is likely autoimmune (i.e., a condition in which your immune system mistakenly
attacks normal parts of the body, resulting in tissue injury or disease).
Dermatitis herpetiformis is uncommon. It typically affects adults between 20 and
60 years of age, although it may erupt in children. It occurs in males twice as
often as in females. This condition is hereditary but not infectious or
cancerous. Other members of your family may have a history of dermatitis
herpetiformis. Hot, humid weather may trigger an eruption of the skin lesions.
Some individuals with this condition have gluten sensitivity and celiac disease,
genetic disorders of
the small intestine in
which an individual cannot normally digest gluten, a major protein in wheat.
Diagnosis is usually based upon the appearance of the skin lesions. Your doctor
may perform a skin biopsy (i.e., removal of a small piece of skin or other
tissue) for laboratory evaluation to assist in diagnosis. Your doctor may also
order blood tests to check for certain immune markers that may aid in the
diagnosis. Dermatitis herpetiformis is a chronic condition in which episodes may
persist for days, weeks, months, or even years. Periods of remission occur
between episodes. Treatment can control symptoms and may lessen the severity and
duration of the skin lesions, but does not cure the disease.
Living With Your
Skin lesions are very itchy
and may occasionally cause a burning or stinging sensation. Lesions appear as
clusters of blisters that are typically symmetric (i.e., develop simultaneously
in similar patterns on both sides of your body). Scratching the lesions can
cause abrasions, crusting, and secondary bacterial infections. Lesions typically
involve the scalp, face, elbows, forearms, knees, shoulder blades, lower back,
and buttocks. Scratching may cause secondary bacterial infections requiring
antibiotic therapy. After healing, the skin may show spots of darker
pigmentation. If you also have celiac disease (see above), you may or may not
have symptoms. Symptoms include diarrhea, weight loss, fatigue, and abdominal
gas, which can cause cramping and bloating. Diagnosis of celiac disease usually
requires a biopsy of the small intestine and blood tests for immune markers. You
may also experience social embarrassment because of your skin’s
treatment of dermatitis herpetiformis depends upon its location and severity,
the impact it has on the quality of your life, and your response to therapy.
Treatment lessens the severity of your condition and prevents complications, but
it does not cure dermatitis herpetiformis. Treatment includes the avoidance of
precipitating factors, general measures, and
• Cool-water soaks to soothe
irritation and decrease itching.
Restricting gluten in your diet, which can suppress dermatitis herpetiformis or
may allow you to decrease the dosage of your medication. Your doctor may
prescribe a variety of medications to reduce inflammation, improve symptoms such
as itching, and lessen the severity and duration of your dermatitis
herpetiformis. These medications
• Topical steroid creams,
lotions, and ointments to reduce inflammation. These medications are effective.
Exercise caution when using topical steroids because they may be absorbed
through your skin into your bloodstream and cause toxic
• Calamine lotion and
similar agents can reduce itching and
• Antihistamines reduce
itching and may allow you to rest more easily. They may cause drowsiness, so use
these agents cautiously when driving or performing other activities in which you
must be awake and alert.
• Dapsone or
sulfapyridine may be prescribed to reduce skin eruptions and blistering. You
will probably need to take one or both of these agents for an extended time.
Your doctor will likely monitor for side effects by checking periodic blood
tests. Side effects include hemolytic anemia, peripheral neuropathy (tingling,
numbness, or loss of feeling), muscle weakness, and liver
• Take medications as
prescribed by your doctor. Inform your doctor of all other medications,
including over-the-counter medicines, that you are now taking. Continue these
medications unless your doctor instructs you to stop
• Read the labels of medicines
and follow all instructions. Consult your doctor if you have any concerns or if
you have side effects caused by the
• Eliminating or
restricting gluten in your diet may improve your condition or may allow you to
reduce the dosage of medications used to treat dermatitis herpetiformis.
• Avoid activities that cause
overheating and excessive sweating or moisture. If you perform activities that
result in excessive moisture, immediately shower and cleanse the skin
• Maintain good skin hygiene
to reduce the risk of secondary bacterial
• Keep scheduled follow-up
appointments with your doctor. They are essential to monitor your condition,
your response to therapy, and to screen for possible side effects of
• Monitor your skin for
healing and for evidence of secondary bacterial infection. Signs and symptoms of
infection include redness around the skin lesions, purulent discharge (pus),
increased pain or swelling of the skin lesions or lymph nodes, and
• Frequently wash clothing,
towels, and linens as skin lesions are oozing, crusting, or may be infected.
This action reduces the risk of transmission of
• Do not stop your
medicine or change the prescribed dose without consulting your doctor. Do not
exceed recommended doses of medicines, because higher doses may increase your
risk of toxic effects.
• Do not use
potent topical steroids on the face or genitals because these areas are most
prone to skin injury and atrophy (thinning and wasting of the skin associated
with wrinkling and abnormal, small blood
• Do not drive or perform
other potentially hazardous activities when taking medication that can cause
drowsiness or sedation (e.g.,
• Avoid activities
that can cause overheating, sweating, or excessive moisture, because these
conditions can trigger or aggravate your dermatitis
• Avoid activities
that can cause infection of the skin
When to Call Your
• If any signs or symptoms
of infection develop (see above).
If you notice that lesions are becoming worse or if new lesions appear despite
• If new or
unexplained symptoms develop that may indicate a complication of your condition
or a side effect of treatment.