Dermatitis herpetiformis
Duhring disease; DH
Dermatitis herpetiformis (DH) is a very itchy rash consisting of bumps and blisters. The rash is chronic (long-term).
Dermatitis herpetiformis is a chronic inflammatory disease that produces lesions that burn and itch intensely. This is a close-up of dermatitis herpetiformis lesions. The lesions are red (erythematous) and may be slightly raised (papular), form small pus-filled areas (pustules), or there may be blisters (vesicles). The disease develops suddenly and may last from weeks to months. It may occur in association with gluten (wheat) sensitivity and allergy.
This picture shows the knee of a person with a chronic inflammatory disease known as dermatitis herpetiformis. It produces red, raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases (such as Celiac disease).
This picture shows a chronic inflammatory disease (dermatitis herpetiformis) that produces red (erythematous), raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases (such as Celiac disease).
This picture shows the thumb of a person with a chronic inflammatory disease known as dermatitis herpetiformis. It produces red, raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases such as celiac disease.
This picture shows the fingers of a person with a chronic inflammatory disease known as dermatitis herpetiformis. It produces red, raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases such as celiac disease.
This picture shows the forearm of a person with a chronic inflammatory disease known as dermatitis herpetiformis. It produces red, raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases such as celiac disease.
Causes
DH usually begins in people age 20 and older. Children can sometimes be affected. It is seen in both men and women.
The exact cause is unknown. Despite the name, it is not related to the herpes virus. DH is an autoimmune disorder. There is a strong link between DH and celiac disease. Celiac disease is an autoimmune disorder that causes inflammation in the small intestine from eating gluten. People with DH also have a sensitivity to gluten, which causes the skin rash. About 25% of people with celiac disease also have DH.
Symptoms
Symptoms include:
- Extremely itchy bumps or blisters, most often on the elbows, knees, back, and buttocks.
- Rashes that are usually the same size and shape on both sides.
- The rash can look like eczema.
- Scratch marks and skin erosions instead of blisters in some people.
Most people with DH have damage to their intestines from eating gluten. But only some have intestinal symptoms.
Exams and Tests
In most cases, a skin biopsy and direct immunofluorescence test of the skin are performed. The health care provider may also recommend a biopsy of the intestines. Blood tests may be ordered to support the diagnosis.
Treatment
An antibiotic called dapsone is very effective.
A strict gluten-free diet will also be recommended to help control the disease. Sticking to this diet may eliminate the need for medicines and prevent later complications.
Medicines that suppress the immune system may be used, but are less effective.
Outlook (Prognosis)
The disease may be well-controlled with treatment. Without treatment, there may be a significant risk of intestinal cancer.
Possible Complications
Complications may include:
- Autoimmune thyroid disease
- Develop certain cancers, especially lymphomas of the intestines
- Side effects of the drugs used to treat DH
When to Contact a Medical Professional
Call your provider if you have a rash that continues despite treatment.
Prevention
There is no known prevention of this disease. People with this condition may be able to prevent complications by avoiding foods that contain gluten.
References
Hull CM, Zone JJ. Dermatitis herpetiformis and linear IgA bullous dermatosis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 31.
Lebwohl B, Green PHR. Celiac disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 107.
Version Info
Last reviewed on: 6/7/2023
Reviewed by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
