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  • Scott Adams
    Scott Adams

    The Gluten Intolerance Group of North America on Iodine and Dermatitis Herpetiformis

    The the connection between iodine and Dermatitis Herpetiformis is briefly described by the following excerpt from a resource guide of the Gluten Intolerance Group of North America:

    • Iodine can trigger eruptions in some people (with dermatitis herpetiformis). However, iodine is a essential nutrient and should not be removed from the diet without a physicians supervision.
    • Iodine does not contain gluten. Iodine can worsen the symptoms of skin lesions in patients with dermatitis herpetiformis.
    • When the deposits of IgA have been cleared from the skin over time by following a gluten free diet, iodine should no longer present any problem for dermatitis herpetiformis patients.

    As background, for those who are not familiar with Dermatitis Herpetiformis, the following description comes from a resource guide of the Gluten Intolerance Group of North America:

    • Dermatitis herpetiformis (dermatitis herpetiformis) is a chronic disease of the skin marked by groups of watery, itch blisters. The ingestion of gluten (the proteins gliadin and prolamines contained in wheat, rye, oats, and barley) triggers an immune system response that deposits a substance, IgA (immonuglobin A), under the top layer of skin. IgA is present in affected as well as unaffected skin. dermatitis herpetiformis is a hereditary autoimmune disease linked with celiac disease. If you have dermatitis herpetiformis, you always have celiac disease. With dermatitis herpetiformis the primary lesion is on the skin rather than the small intestine. The degree of damage to the small intestine is often less severe or more patchy then those with only celiac disease. Both diseases are permanent and symptoms/ damage will occur after comsuming gluten.

    When my husband was diagnosed with dermatitis herpetiformis last November, he went to visit a expert in dermatitis herpetiformis, Dr. John J. Zone, at the University of Utah (USA). The written instructions Dr. Zone gave him included the following statement:
    • The mineral iodine is known to make the disease (dermatitis herpetiformis) worse. For this reason, foods and supplements high in iodine should be avoided. Table salt which is not iodized should be used. This can be found in most grocery stores with the other salts. Avoid kelp and other seaweed products, and do not use sea salt. If you take any nutritional supplements, examine them carefully to avoid any iodine containing ingredients.

    It is not necessary for dermatitis herpetiformis patients to eliminate iodine completely from their diet, merely to avoid foods high in iodine as described above. Dr. Zone also explained that dermatitis herpetiformis patients need not avoid iodine indefinitely. Iodine is an important mineral for our bodies. dermatitis herpetiformis patients can stop avoiding iodine when their rash symptoms clear up which can take anywhere from a few months to a couple of years on a gluten-free diet.

    More about iodine:

    • Intake of large amounts of inorgana iodide is known to exacerbate symptoms and a few patients have been reported to improve on low iodide diets. However, this is not a mainstay of treatment and need only be considered if patients are consuming excessive iodide in the form of vitamin pills, kelp, or seafood. Likewise, some patients have reported exacerbation with thyroid hormone replacement therapy and thyrotoxicosis. In such cases, excessive thyroid replacement should be avoided and thyrotoxicosis treated appropriately.
    • Dermatitis Herpetiformis, John J. Zone MD, Curr Probl Dermatol, Jan/Feb 1991, p36
    • Dermatitis Herpetiformis is considered a rare skin disease.
    • The true incidence and prevalence of dermatitis herpetiformis appears to vary in different areas of the world and may vary within the same country. During 1987, 158 cases of documented dermatitis herpetiformis were identified in the state of Utah out of a population of 1.6 million, a prevalence of 9.8 per 100,000.
    • Dermatitis Herpetiformis, John J. Zone MD, Curr Probl Dermatol, Jan/Feb 1991, p15


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    Having been recently diagnosed. I was unaware about Iodine's role, which makes me believe that staying away from shell fish (for 20 years) has played some role in this illness. Thank you

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    An eye opener, no one ever told me about this link. I have used sea salt since diagnosis, found I have an intolerance to all seaweed products, and now I'm wondering if this is why I can't get my dermatitis to clear up. Thanks for starting this thought process!!

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    I made the connection between my Dermatitis Herpetiformis and iodine 16 years ago and was able to clear up the blisters by avoiding sources of iodine. However, even after I found out I had celiac five years ago, I didn't connect the blister outbreaks to celiac until I read Dr. Green's book. When he stated that iodine was the trigger, I almost jumped out of my chair. Now everything was clear-- celiac was actually the cause, while iodine was merely the trigger. Unfortunately, because I avoided iodine for 16 years, my thyroid essentially 'died' last year, and since all thyroid meds contain iodine, I break out in blisters at the slightest gluten contamination. My back is also covered with an itchy rash, my throat is sore, and my thyroid is inflamed. My doctors seem at a loss at treating this sensitivity to iodine. So, I would like to reiterate Dr. Green's advice to not completely avoid iodine--your thyroid needs it to be healthy.

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    Thank you for this insightful information. I have always found that my eczema gets worse when I eat prawns and now I know why. I will definitely be on the look-out for foods high in iodine in the future so as to avoid them.

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    Really helpful. Since so many of us have thyroid problems too and must take supplements, this is a big issue. There is not much clear information out there and doctors don't seem so well informed.

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    My son Andrew is 15 years old now, he was diagnosis with Dermatitis Herpetaformis at 8, has been rash-free for 5 years by being on a Gluten Free diet continuously and Iodine free diet for approximately 6 months after his initial diagnosis). He has recently relapsed, I believe he has been eating more fast foods, going through puberty, and has been in the ocean 3-4 times a week for several months now possibly absorbing iodine through his skin. I am unsure if puberty and the absorption through the skin can trigger Dermatitis Herpetaformis. He is looking and feeling terrible, so frustrating for him and me as a mother.

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    At 33 years old I finally got diagnosed with celiac this year with a simple blood test (after 3 years of gut pain). To make up for my lack of vitamins - I was taking a fantastic, all inclusive vitamin religiously in addition to a gluten free diet. My gut was great, but I got wicked cases of 'poison ivy' 3 times in one summer - a record even for me. THANK YOU for this article. I switched off the vitamin, which was high in iodine and haven't had a major outbreak since. I did get a prescription for Fluocinonide .05% a topical steroid that helped before I knew to cut back on iodine. Now it seems that I can usually just cut back on shrimp intake (had a flare up on vacation when eating lots of shrimp) and that stops the rash from spreading and turning into the big bumps.

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    Usually going in the ocean soothes skin rashes. Does anyone know if it's bad for a person with Dermatitis Herpetiformis to go into the ocean?

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    Thank you! I recently started taking kelp, and the watery blisters I got from gluten intolerance multiplied and became worse. I had no idea about the relationship between the two until now.

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    Usually going in the ocean soothes skin rashes. Does anyone know if it's bad for a person with Dermatitis Herpetiformis to go into the ocean?

    Live in Hawaii and our ocean is like a medicine for lots of ailments. BUT, nowadays, if you have an open cut, it's advised not to go into the ocean. There are "new unknown" bacteria or particles in the ocean more than ever. Your little cut can become infected so quickly. In my days, it was good to go into the waters and have nature's ocean clean the cut and heal it.

    I'd say, with an inflamed case of dermatitis herpetiformis, don't go in the waters. When my son's skin looks better I'll take him to the beach. He'll even tell me when his skin feels better.

     

    My 7 year old son just got diagnosed with dermatitis herpetiformis. With the help of a new dermatologist, my son's mystery skin has a name. Our doctor was so nice to explain to me about dermatitis herpetiformis and its nickname "suicidal itch".

     

    After 5 years of 3 dermatologists, 1 allergist, and pediatricians all saying that he just has an extreme eczema or dyshidrosis or some severe mystery skin. Though I had pictures of his "angry skin", no one went outside the "box" of eczema. I knew something was different. Every one would tell me that they knew what we were going through, Yet none of them could understand or relate to me and my son when I told them that there has been lots of staph infections and ER nights and just no sleeping.

    Even my son's school staff has been challenging.

     

    Sorry, just so happy with this new world of dermatitis herpetiformis and trying to go gluten-free 100% (or as much as possible) yet a little perturbed with professionals that are closed minded to "outside of the box" learning something new.

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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    Kristen Campbell
    Gluten intolerance often presents itself in ways unexpected, including several common skin conditions.  Ranging in severity from dermatitis herpetiformis to dry skin, avoiding gluten may have more to do with your plaguing skin concerns than you imagined.
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    Dermatitits Herpetiformis—This painful, blistery condition can be very stressful, especially when misdiagnosed.  An inflamed, itchy rash, dermatitis herpetiformis begins as tiny white filled blisters or red spots around hair follicles.  Trying to hide or disguise DH, as well as trying to treat it when misdiagnosed can be incredibly stressful for a person. Eczema—Eating a gluten-free diet is becoming an increasingly popular mode of treatment for eczema.  Those who are gluten intolerant also tend to have more advanced psoriasis.Psoriasis—Like eczema, psoriasis has in many cases shown improvement when the person is put on a gluten free diet.  In Scott Adams’ 2004 article, he also mentioned that psoriasis in those with celiac tends to be more severe. Acne—Links between celiac and malabsorption, as well as hormonal upset can contribute to a greater production of acne.  Many birth control pills boast promises of clearer skin, their method is through hormone manipulation.  Because many who suffer from gluten intolerance also experience a disruption of normal hormone function, this disharmony can lead to problems with acne.  Dry Skin—Also correlated to malabsorption, dry skin is a very common complaint amongst those with celiac.  But this condition is one that many people see even after the prescribed treatment of a gluten free diet.  Why?  Vitamin E rich grains are vital to maintaining skin harmony, but since many who are gluten intolerant begin avoiding grains completely—even those grains that are gluten-free, getting that important Vitamin E in their diets can become a challenge.


    Miranda Jade
    Celiac.com 04/25/2012 - In my experience growing up with undiagnosed celiac disease, I had to deal with several symptoms that my doctors had no answers for. One of the most frustrating of these was my skin troubles—dermatitis herpetiformis. After my experiences with misdiagnoses, and finally more recently, learning how to effectively get rid of dermatitis herpetiformis, I encourage parents to be particularly watchful for signs of dermatitis herpetiformis in their children, and I have some useful advice for those—children and adults—who have already been diagnosed with this annoying and sometimes quite troublesome rash. Since dermatitis herpetiformis occurs in 15 to 20% of celiacs, it’s worth any celiac’s time to learn more about this condition.
    By definition, dermatitis herpetiformis is a blistering and extremely itchy skin rash. It’s usually symmetrical in shape and is most commonly located on the elbows, knees, buttocks, and upper back. It’s common for people with dermatitis herpetiformis to have rashes appear in the same spot, and they can either be consistent or come and go. People can experience the rash on other parts of the body, and severity of symptoms can vary. Dermatitis herpetiformis is sometimes called the “gluten rash” or “celiac disease rash” because it occurs in people with a gluten intolerance or celiac disease. It is commonly misdiagnosed as eczema.
    Gluten is a protein found in wheat, barley, and rye. In people who have celiac disease, gluten causes an autoimmune response which results in the immune system attacking the lining of the small intestine—specifically the villi, the absorptive hair-like structures of the lining. With dermatitis herpetiformis, outbreaks are also triggered by gluten.
    Interestingly, unlike celiac disease which appears more in women than men, dermatitis herpetiformis is more commonly found in men by a ratio of about two-to-one. It is rarely seen in children under ten and first appears in the teenage years or even in one’s twenties or thirties. It may come and go, even if you’re eating a gluten-containing diet.
    Diagnosis is done with a skin biopsy. In most cases, a dermatitis herpetiformis diagnosis means celiac disease as well, even if you’re not obviously suffering from the characteristic intestinal symptoms of this disease. No matter what, the treatment is the same: a strict gluten-free diet.
    Dermatitis herpetiformis rashes are treated in two main ways--the gluten-free diet, of course, and antibiotics such as dapsone or sulfapyridine for those who aren’t able to tolerate dapsone. A truly gluten-free diet can eliminate dermatitis herpetiformis, but in my experience and according to the National Institutes of Health, a dermatitis herpetiformis rash responds dramatically to dapsone, within 48 to 72 hours. To treat the underlying cause of dermatitis herpetiformis, which is celiac disease, a strict gluten-free diet must be followed, but according to the National Institutes of Health, “Even with a gluten-free diet, dapsone or sulfapyridine therapy may need to be continued for 1–2 years to prevent further dermatitis herpetiformis outbreaks.”
    As a celiac with dermatitis herpetiformis, completely eliminating gluten from my diet has been the only lasting solution for dermatitis herpetiformis, but unfortunately I can accidentally ingest gluten from time to time, especially when I travel. In my most recent outbreak, I decided to get a prescription for dapsone. Although dapsone is a very strong drug with side effects and should be used sparingly, I was in need of something fast-acting. I followed the instructions exactly, and not only did it relieve the pain but within three days, I could see a remarkable change in the appearance of the dermatitis herpetiformis. After reexperiencing the painful and frustrating symptoms of dermatitis herpetiformis and the relief that came with proper treatment, I knew I had to address this topic to help others. I encourage everyone to get the word out about dermatitis herpetiformis so more and more people dealing with this misdiagnosed condition can get help just as I did.
    Resources:
    About.com: Dermatitis Herpetiformis, The ‘Gluten Rash’. Celiac Disease Awareness Campaign: Dermatitis Herpetiformis. eMedecine.Medscape.com: Dermatitis herpetiformis.

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    Thanks Posterboy, that was interesting information.  I believe that I had read something elsewhere about tetracycline, at least, being used instead of, or along with, Dapsone for severe or refractory cases of DH. Unfortunately, even if I had medical insurance (which I do not), and had a regular doctor who was even willing to recognize and accept my condition for what it is, I don't know what kind of luck I would have in persuading that hypothetical doctor to give me a particular and non-sta
    Healthysquirrel,  Please have your doctor check your Vitamin D level!   Vitamin D deficiency is related to vertigo https://www.ncbi.nlm.nih.gov/pubmed/27386060 Vitamin D can help with high IgE https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263170/ Low vitamin D and low ferritin are tied https://www.ncbi.nlm.nih.gov/pubmed/29385099 Dry eye problems including blepharitis can be helped with vitamin d and vitamin a https://www.ncbi.nlm.nih.gov/pmc/articles
    He's still going to have to eat gluten even for an endoscopic biopsy. 2 weeks minimum. Plus guidelines say no dx on an endoscopic biopsy alone - you have to have the positive blood to go with it. Even that 2 weeks will deposit more antibodies under his skin if he's got dh.  Let me put it this way. The gut damage is the gut damage & if he's celiac & it sounds like he is but we don't have labs to prove it, then there is a treatment for it. Only 1 treatment for it. A very strict gluten
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