What is dermatitis herpetiformis (DH)?

Dermatitis herpetiformis (DH) is an itchy, blistering skin condition that is a form of celiac disease. The rash usually occurs on the elbows, knees, and buttocks, and is characterized by its bilateral nature, which means that both knees and/or both arms are affected, seldom just one.

Many people with DH have no digestive symptoms and only about 40% of them have positive blood tests (serology) for celiac disease; however, they almost always have the same gluten-dependent intestinal damage as people with celiac disease.

Unless otherwise specified, the information pertaining to celiac disease also pertains to people with dermatitis herpetiformis. In addition to following a strict gluten-free diet, DH is also commonly treated with a medication called dapsone.

No. Celiac disease affects at least 1% of Americans, or nearly 3 million people in the United States. By comparison, Alzheimer’s disease affects approximately 2 million people. It is possible to be diagnosed with celiac disease at any age.

Celiac disease affects people differently. There are more than 200 signs and symptoms of celiac disease, yet a significant percentage of people with celiac disease have no symptoms at all. However, people without symptoms are still at risk for some of the complications of celiac disease.

Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has infertility or anemia. Some people develop celiac disease as children, others as adults.

Symptoms of celiac disease may include one or more of the following:

  • Recurring abdominal bloating and pain
  • Chronic diarrhea/constipation
  • Vomiting
  • Liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
  • Weight loss
  • Pale, foul-smelling stool
  • Iron-deficiency anemia that does not respond to iron therapy
  • Fatigue
  • Failure to thrive or short stature
  • Delayed puberty
  • Pain in the joints
  • Tingling numbness in the legs
  • Pale sores inside the mouth
  • A skin rash called dermatitis herpetiformis (DH)
  • Tooth discoloration or loss of enamel
  • Unexplained infertility, recurrent miscarriage
  • Osteopenia (mild) or osteoporosis (more serious bone density problem)
  • Peripheral neuropathy
  • Psychiatric disorders such as anxiety and depression

Young children tend to have the more classic signs of celiac disease, including growth problems (failure to thrive, chronic diarrhea/constipation, recurring abdominal bloating and pain, fatigue, and irritability.

Older children and adults tend to have symptoms that are not entirely gastrointestinal in nature. Recent research has demonstrated that only a third of adult patients diagnosed with celiac disease experience diarrhea. Weight loss is also not a common sign. The most common sign of celiac disease in adults is iron deficiency anemia that does not respond to iron therapy.

Yes. Recent research has demonstrated that a significant percentage of children and adults with positive celiac blood tests had no, or minimal, symptoms when they were tested. Further, there are a few patients who carry the gene for celiac disease, have no or minimal symptoms, and negative blood tests, yet a positive biopsy shows that the disease is active.

Refractory sprue is the term used when persistently damaged villi in the small intestine are not repaired after the gluten free diet has been successfully initiated and/or maintained, and other potential causes for the damage have been ruled out.

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Celiac Disease