Duhring disease; DH
Dermatitis herpetiformis (DH) is a very itchy rash consisting of bumps and blisters. The rash is chronic (long-term).
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.
Most people with DH have damage to their intestines from eating gluten. But only some have intestinal symptoms.
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 confirm the diagnosis.
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.
Drugs that supress the immune system may be used, but are less effective.
The disease may be well-controlled with treatment. Without treatment, there may be a significant risk of intestinal cancer.
Complications may include:
Call your provider if you have a rash that continues despite treatment.
There is no known prevention of this disease. People with this condition may be able to prevent complications by avoiding foods that contain gluten.
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.
Kelly CP. Celiac disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 107.BACK TO TOP
Review Date: 4/16/2019
Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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