What Is Dermatitis Herpetiformis? What Can You Do About It?

Dermatitis herpetiformis is a disease that causes intense itching with a skin inflammation resembling hives. Because the itching is so intense, patients often have no sign of the original lesions by the time they go to the doctor, because the original areas of skin inflammation are covered by raw abrasions and crusts induced by scratching. Itching frequently has a burning or stinging component.

The onset of burning and stinging reliably predicts the eruption of whelps on the skin 12 to 24 hours later. This vexing ski condition is a cutaneous manifestation of the intestine’s reaction to gluten in food. In dermatitis herpetiformis, however, the IgA granules travel to the junction of the skin’s upper and lower layers.

Since healing dermatitis herpetiformis with diet takes several months, many people with the condition opt to be treated with the antibiotic dapsone. This drug relieves symptoms in 24 to 48 hours, but anyone who takes more than 100 milligrams of the drug per day develops anemia. Other side effects may include damage to the bone marrow and liver, headache, and depression.

Since the rash returns very quickly when the antibiotic is discontinued, the typical treatment strategy with dapsone and other agents for dermatitis herpetiformis is to find the lowest dosage possible while controlling symptoms, so that side effects diminish over time. As the British expert in the disease Dr. Lionel Fry notes, “Since side effects tend to occur early in treatment, patients may only have to attend hospital every six months once established on drug treatment.”

Although natural healing of dermatitis herpetiformis requires discipline, it is free of side effects. Many sufferers of this form of dermatitis will choose the middle ground between medical and natural treatment, taking prescription drugs short-term to control symptoms while waiting for diet to control the underlying disease.


A gluten-free diet is key to healing dermatitis herpetiformis. A twenty-five year study of dermatitis herpetiformis in the United Kingdom found that about a third of patients experience complete remission of symptoms simply by removing wheat and other gluten products from the diet. Virtually all of the remaining two-thirds of patients achieved partial relief of symptoms by partial adherence to the diet. People with this condition who follow a gluten-free diet are also at much lower risk for developing lipomas, tumors of fatty tissue just beneath the skin.

Most medical authorities note that about 10 percent of people with the disease do not respond even to rigorous elimination of gluten products from the diet. Eliminating milk and eggs can help most of the dermatitis herpetiformis sufferers in this group. An enzyme-linked immunoassay (ELISA) of people who have dermatitis herpetiformis has found that about 75 percent have serum antibodies reactive against gliadin, cow’s milk, or the albumin protein in eggs.

Completely eliminating milk and eggs followed by carefully reintroducing them in small amounts several months later is a good test of the potential efficacy of permanently eliminating them from the diet. Some milk- and egg-sensitive dermatitis herpetiformis sufferers will be able to tolerate small amounts of these foods if they strictly adhere to the gluten-free diet.