What is Dermatitis Herpetiformis?
Dermatitis herpetiformis (Duhring disease) is a rare autoimmune disorder characterized by bumps, blisters and extremely itchy rashes. It is a skin disease associated with gluten sensitivity, which is characteristic of celiac disease.
Dermatitis herpetiformis often occurs in people living in Northern Europe (particularly Sweden and Ireland) or in people of Northern European descent. It is rare among Asians and Africans. It usually develops between the second and fourth decades of life and affects males slightly more than females.
Symptoms of dermatitis herpetiformis usually appear on the arms, elbows, back, buttocks, and knees. The rashes usually look like blisters and bumps, but in some, they may resemble eczema or look like scratch marks. These are extremely itchy, and sometimes burning and stinging. Scratching can leave scabs. Most patients have an intolerance to gluten, a natural substance found in certain foods like wheat, barley, and rye. Gluten intolerance causes celiac disease, a gut condition that is closely linked to dermatitis herpetiformis.
Usual medical treatments for dermatitis herpetiformis consist of antibiotic treatment with dapsone, which is very effective, following a strict gluten-free diet, and immunosuppressive medications, which are less effective.
What is a Gluten-Free Diet?
Following a gluten-free diet is a lifelong commitment that is difficult to achieve. Gluten is a protein found in many foods that people consume everyday especially those that contain wheat, barley, or rye. Some oats contain gluten, but studies show that eating oats in moderation does not worsen celiac disease or dermatitis herpetiformis. Improvement of symptoms with a gluten free diet usually takes several months.
It may take some time for most people to switch to a gluten-free diet, especially if they have to eliminate foods that they usually like to eat. Therefore, it may be more helpful to know and focus on what foods they can eat, rather than those that they are not allowed to eat. Many grocery stores sell gluten-free products. It is also advisable to consult a dietitian who can offer advice about how to eat a healthy, balanced diet while avoiding gluten-containing foods.
Here are some delicious and healthy foods that are naturally gluten-free:
- Beans, nuts and nuts (unprocessed forms)
- Fresh eggs
- Fresh meat, poultry, and fish (not marinated or breaded)
- Most dairy products
- Fruits and vegetables
It is important to make sure that you eat these foods not mixed or processed with gluten-containing ingredients such as grains, preservatives, or additives.
Grains and starches that can be included in a gluten-free diet include:
- Corn, cornmeal
- Flours made from rice, bean, corn, soy, potato
These gluten-containing foods must be avoided:
- Barley-containing foods like malt, malt vinegar, and malt flavoring
- Triticale (similar to wheat and rye)
Wheat products to avoid:
- Durum flour
- Graham flour
In general, it is best to avoid the following foods if they are not labeled “gluten-free”:
- Cakes, pies
- Cookies, crackers
- Communion wafers
- French fries
- Imitation meat /seafood
- Luncheon meats
- Sauces, soy sauce
- Salad dressings
- Seasoned rice mix
- Potato chips, tortilla chips, and other seasoned snack foods
- Self-basting poultry
- Soup bases and soups
- Vegetables with sauce
Foods labeled as “gluten-free” contain less than 20 ppm (parts per million) of gluten, but be sure that there is no cross-contamination with gluten-containing ingredients. Some products labeled “wheat-free” might contain gluten. To be sure, check the list of ingredients. If you are not sure whether the food contains gluten, do not buy it or ask the manufacturer what it contains.
Be careful about preparing or cooking foods at home, where cross-contamination can also occur. For example, surfaces or utensils that have been used for preparing gluten-containing foods may not have been thoroughly cleaned. A common toaster for heating regular bread and gluten-free bread is a possible source of contamination.
Patients are also advised to be careful when eating out at restaurants. It is best to ask the restaurant staff for gluten-free foods.
Risks of Following a Gluten-Free Diet
The most important risk of following a gluten-free diet that eliminates some foods is not getting enough vitamins. People who follow a strict gluten-free diet may not get enough nutrients and have low levels of certain vitamins in their diets. These include:
Some people may also not get enough fiber in this type of diet. To avoid these deficiencies, patients are advised to eat more fruits and vegetables and other gluten-free foods that contain these nutrients. In patients who are not able to eat a balanced diet, some health providers may recommend taking health supplements like multivitamins to correct these deficiencies. However, one must be careful about checking the ingredients of these health supplements, since some of them contain binders that consist of gluten. Look for gluten-free health supplements or ask your doctor for advice.
This information should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health.
Medscape. Dermatitis herpetiformis. http://emedicine.medscape.com/article/1062640-overview
UMMC. Dermatitis herpetiformis.http://umm.edu/health/medical/ency/articles/dermatitis-herpetiformis
Mayo Clinic. Gluten-free diet. http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530