Can DH itch be mild?

[EF-ATL]

Hi all,

I've been dealing with some debilitating immune issues, mainly neuropathic pain, for the past few months, and it all seems to date back to a bumpy rash that appeared on both knees and elbows in June. My derm DX'd it as Gianotti Crosti, a post-viral rash that usually occurs in kids (I'm 36). She said my rash did present like DH, but if it were DH, it would be far itchier. My rash does itch when it first forms, but only mildly. Then minimal itching as it slowly dries out over weeks.

When the rash and nerve/muscle pain started, I was gluten-free but not strict about cross-contamination. Since then, I have gone strictly gluten-free, still chancing takeout food with caution. The rash has briefly flared twice since then-- once in August (knee) and once in October (elbows). Seems strange for a viral rash to keep flaring like that, but lord knows the immune system is mysterious. (For what it's worth ... perhaps very little ... I tested negative for COVID antibodies.)

The reason I'm still stuck on DH is that on the day the rash showed up in October, I know I had accidentally eaten soy sauce at a family function. So if the rash is not gluten-related, that seems like a cruel coincidence.   (gluten-free tamari does not cause a reaction.)

I guess my question is, can one have DH (or another gluten-caused rash???) that isn't terribly itchy? Thanks!

 

 

[knitty kitty]

EF_ATL,

I get DH and mine isn't always massively itchy.  DH is usually diagnosed by taking a biopsy next to a blister and doing an immunofluorescent stain to detect antibodies.  

There are other not so itchy skin manifestations of Celiac Disease.  One is keratosis pilaris

"Gluten And Chicken Skin (Keratosis Pilaris )"

https://theceliacmd.com/gluten-and-keratosis-pilaris-chicken-skin/

"it can be caused by vitamin A deficiency or essential fatty acid deficiency, both of which can occur with impaired absorption. If you have celiac disease or gluten sensitivity you theoretically might suffer from keratosis pilaris flare-ups if you are consuming gluten and have ongoing inflammation or malabsorption."

And I found this article that describes various skin rashes associated with gluten....

"Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586563/#!po=24.1935

But the pictures in your previous posts sure look like DH to me, but I'm not a doctor.  Is your dermatologist familiar or experienced with diagnosing DH by biopsy?

I'm concerned about the muscle pain and neuropathy you mentioned which can be indicative of vitamin deficiencies.  Neuropathy can cause decreased sensation, so you might not feel the itchiness.

Nicotinic acid (vitamin B3) deficiency can cause little blisters that scale over as they heal, and cause darkening of the skin exposed to the sun.  And Niacin deficiency can cause neuropathy and muscle weakness.  This article describes the skin manifestations in detail.

"Nicotinic Acid Deficiency"

https://www.ncbi.nlm.nih.gov/books/NBK557749/#!po=9.25926

Deficiencies usually occur in more than one vitamin at a time.  There are other vitamins that cause neuropathy when low or deficient, such as B12, Niacin, Thiamine, B6. You may want to get checked for vitamin and mineral deficiencies by your doctor.  

Vitamin A and Vitamin D and those omega 3 fats are not absorbed well in Celiac Disease and may be in short supply on a gluten free diet.  

The B vitamins I mentioned earlier may also be low in the gluten free diet.  A B-Complex vitamin supplement may ensure you get enough.  

Talk to your doctor about checking for deficiencies.  

Hope this helps!

[EF-ATL]

That’s interesting to hear that your DH isn’t always terribly itchy. Here is another photo of my most recent flare-up, which started overnight on the same day I accidentally ate gluten, bloomed for a few days, and eventually dried up. That was 9/26, and the rash hasn’t reappeared since.

I’m wiling to get it biopsied when it happens again, but I’m already strictly gluten-free and worried the results won’t be accurate. I’m actually waiting on intestinal biopsy results now, but worried about their accuracy for the same reason. (I’ve been mostly gluten-free for years and strictly gluten-free since June.) My fear is getting an official negative diagnosis but actually having the disease, and then my husband and relatives won’t take it seriously. Ugh. 

Thanks so much for following my various posts and piecing my issues together.  This nerve and muscle pain is no picnic. I am underweight so I definitely think I need to get a complete workup re. vitamin/minerals. I’ve gotten a few done and was “low-normal” on all (b12, mag, D).

Thanks for that useful info re. rashes!