Dermatitis Herpetiformis

Skin Changes in Celiac, Thyroid disorders, Sjogren's, Arthritis, Diabetes, and Vitiligo

Dermatitis herpetiformis, once considered celiac disease of the skin, is known to occur in a number of different autoimmune disorders, including Graves’ disease, Hashimoto’s thyroiditis, Sjogren’s syndrome, and rheumatoid arthritis.

What is Dermatitis Herpetiformis?

Dermatitis herpetiformis is an autoimmune disorder characterized by chronic, intensely pruritic (itchy) symmetric groups of vesicles, papules, and wheals (hives), that may occur on the elbows, knees, arms, legs, shoulders, scalp, buttocks, neck, and face. Dermatitis herpetiformis, which is also known as Duhrings’s disease, Brocq-During disease, and dermatitis multiformis, usually occurs in people with celiac disease and well as milder forms of gluten sensitivity, and less often, in people with autoimmune thyroid disorders.

Dermatitis herpetiformis has also been reported to occur in people with vitiligo, type I diabetes, Sjogren’s syndrome, dermatomyositis, and rheumatoid arthritis.

Who is Affected

Dermatitis herpetiformis has a typical onset in the late teens and early twenties, or in the third or fourth decades of life, although it can affect people of all ages. Males are affected twice as often as females, and it occurs more often in whites than in people of Asian or African descent.

Symptoms

Dermatitis herpetiformis causes small blisters, discrete papules (bumps, pimples), itchy smooth lesions resembling hives, and waxy lesions. Blisters and papules frequently appear on the face and and may cause intense itching. Clinical signs are often highly variable ranging from groups of papulovesicles with excoriations or eczema-like lesions to minimal variants of discrete redness with small water blisters or areas of small purpura (purple bruise-like lesions).

Untreated, dermatitis herpetiformis tends to wax and wane although with a constant diet of gluten, symptoms persist. It can take a few weeks to several years for symptoms to clear with a gluten-free diet with longer periods required for patients who have had symptoms for a long time before restricting gluten.

Although lesions in the oral mucosa are rare, there are reports of oral lesions occurring early in the stages of dermatitis herpetiformis. These lesions may also be caused by the apthous ulcers (oral blisters) that frequently occur in people with celiac disease.

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