From the Guidelines
Yes, skin rashes can occur with celiac disease, with dermatitis herpetiformis being the most common skin manifestation, affecting about 10-15% of celiac patients. This condition is characterized by an intensely itchy rash that typically appears on the elbows, knees, buttocks, and scalp as clusters of small blisters and bumps. Other skin conditions associated with celiac disease include chronic urticaria (hives), psoriasis, and eczema 1. These skin symptoms occur because gluten triggers an immune response that can affect not only the intestines but also the skin.
Key Points to Consider
- The treatment for celiac-related skin conditions is a strict gluten-free diet, which typically leads to improvement within weeks to months.
- In severe cases of dermatitis herpetiformis, medications like dapsone may be prescribed temporarily to provide relief while the gluten-free diet takes effect.
- If you suspect celiac disease due to skin symptoms, it's essential to get tested before eliminating gluten from your diet to ensure accurate diagnosis, as the diagnosis of CeD in adulthood is based on serology and duodenal biopsy while the patient is on a gluten-containing diet 1.
Important Considerations for Diagnosis and Treatment
- The presence of anti-type 2 transglutaminase antibodies (TG2Ab) in the serum and duodenal histological alterations usually make the diagnosis straightforward.
- A strict gluten-free diet is the primary treatment for celiac disease and related skin conditions.
- It is crucial to follow the guidelines for best practices in monitoring established coeliac disease in adult patients to ensure proper management and follow-up 1.
From the Research
Skin Rash and Celiac Disease
- Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease, presenting with an intense itch and blistering symmetrical rash, typically on the elbows, knees, and buttocks 2.
- The DH autoantigen, transglutaminase 3, is deposited at the same site in tightly bound immune complexes, and diagnosis is confirmed by showing granular immunoglobulin A deposits in the papillary dermis 2.
- DH affects mostly adults and slightly more males than females, with a mean age at onset of about 50 years 2.
Prevalence and Treatment
- The DH-to-celiac disease prevalence is 1:8, and the incidence of DH is decreasing, whereas that of celiac disease is increasing, probably due to improved diagnostics 2.
- The treatment of choice for all patients with DH is a gluten-free diet (GFD) in which uncontaminated oats are allowed, and most patients need additional dapsone to rapidly control the rash and itching at onset 2.
- Dapsone can be stopped after a mean of 2 years, and a strict lifelong GFD alone is required, offering an excellent long-term prognosis for patients with DH, with a normal quality of life and all-cause mortality 2.
Refractory Cases
- Refractory cases of DH with active rash and persistent small bowel atrophy can occur, even after a long period of gluten-free dietary treatment 3.
- A study found that 1.7% of patients with DH had refractory cases, which were characterized by persistent skin immunoglobulin A deposits and normal small bowel mucosa 3.
- Another study found that celiac disease can evolve into DH in patients adhering to a normal or gluten-free diet, and that poor adherence to GFD is often an indicator of this phenotype change 4.