What Does a Gluten Rash Look Like?

Reviewed on 5/5/2021

Gluten rash is a chronic, autoimmune skin condition that occurs in people with celiac disease because of gluten sensitivity. Symptoms of a gluten rash include a rash that looks like red, raised skin lesions/blisters, sores that look like hives, and lesions that occur in groups.
Gluten rash is a chronic, autoimmune skin condition that occurs in people with celiac disease because of gluten sensitivity. Symptoms of a gluten rash include a rash that looks like red, raised skin lesions/blisters, sores that look like hives, and lesions that occur in groups.

Gluten rash (also called dermatitis herpetiformis, DH, and Duhring’s disease) is a rare, chronic, autoimmune skin condition that occurs in people with celiac disease that is a manifestation of gluten sensitivity. 

A gluten rash commonly develops on the elbows, knees, buttocks, lower back, and scalp. The face and groin may be affected less frequently. 

Symptoms of a gluten rash include:

  • Rash that looks like red, raised skin lesions/blisters
  • Sores that look like hives
  • Lesions occur in groups
  • Severe itching 
  • Rash is usually symmetrical and appears on both sides of the body

Other symptoms of dermatitis herpetiformis include: 

  • Defects in tooth enamel: horizontal grooves, pits, or tooth discoloration 
  • Oral ulcerations (canker sores) (rare)
  • Gastrointestinal symptoms

What Causes Gluten Rash?

Gluten rash is caused by a complex combination of genetic and environmental factors. 

  • Genetics: first-degree relatives of patients have an increased risk of both gluten rash (dermatitis herpetiformis) and celiac disease
  • Environment: dietary gluten

How Is Gluten Rash Diagnosed?

Gluten rash (dermatitis herpetiformis) is diagnosed with a patient history and physical examination and a skin biopsy for direct immunofluorescence microscopy (DIF). 

Antibody protein (IgA) deposits are found within the dermis of 92% of patients who have dermatitis herpetiformis. 

Blood tests may be used to support the diagnosis and to monitor if a person is following to dietary therapy recommendations: 

  • Enzyme-linked immunosorbent assay (ELISA) for IgA tissue transglutaminase antibodies
  • ELISA for IgA epidermal transglutaminase antibodies (when available)
  • Indirect immunofluorescence for IgA endomysial antibodies
  • Total IgA level

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What Is the Treatment for Gluten Rash?

The mainstay of treatment for gluten rash (dermatitis herpetiformis) is a strict gluten-free diet and often the antibiotic dapsone. Dapsone usually helps clear symptoms quickly, and the dose can be reduced if patients adhere to a strict gluten-free diet

Other medications used to treat gluten rash in patients unable to take dapsone include: 

  • Sulfapyridine
  • Topical corticosteroids (used short-term)

A dermatologist usually helps manage the skin manifestations of gluten rash, while consultation with a dietician may be recommended to help patients identify and eliminate both sources of dietary gluten, and to find alternatives to gluten-containing foods.

What Are Complications of Gluten Rash?

Gluten rash (dermatitis herpetiformis) is a condition that occurs in people who have celiac disease, and complications are similar to those of celiac disease, including:

How Do You Prevent Gluten Rash?

There is no way to prevent gluten rash (dermatitis herpetiformis) from occurring and patients generally have the condition for life. Strict adherence to a gluten-free diet can minimize symptoms.

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Reviewed on 5/5/2021
References
https://rarediseases.org/rare-diseases/dermatitis-herpetiformis/

https://www.uptodate.com/contents/dermatitis-herpetiformis?search=dermatitis%20herpetiformis&source=search_result&selectedTitle=1~50&usage_type=default&display_rank=1

https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/dermatitis-herpetiformis