Is This Dermatitis Herpetiformis? (pics Inside)

[Jesse E]

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[Michi8]

Maybe...or maybe not. The problem is that the scarring from a lesion can look like so many other skin issues...eczema, psoriasis, etc. You really need a dr to look at an active lesion.

Michelle

[Ursa Major]

Well, I am not saying that it can't possibly be DH. But it looks an awful lot like typical psoriasis to me. Mind you, psoriasis can be caused by celiac disease as well, I am a good example for that.

[JennyC]

To me, it looks like "ring-worm." I know that it sounds gross, but it's really not caused by a worm. It's caused by a fungus-like organism. It is cured by over the counter athlete's foot mediation. (I hop it's gluten-free ) For a while I was prone to this rash. Typically it is seen in people who live in dirty homes with lots of pets (especially cats), according to the doctor I saw. Well, I don't live in a dirty home, or have lots of cats , and you don't have to either. If it is ring-worm the rash should start to fade after a couple days to treatment.

[Ursa Major]

If you scratch it, and dry flakes will come off, leaving a rash with pin-dot bleeding spots, it is pretty much guaranteed to be psoriasis. Why don't you try that and see what happens. If I am wrong, keep looking.

Mind you, even doctors often 'diagnose' psoriasis, even if it is DH.

[Michi8]

To me, it looks like "ring-worm." I know that it sounds gross, but it's really not caused by a worm. It's caused by a fungus-like organism. It is cured by over the counter athlete's foot mediation. (I hop it's gluten-free ) For a while I was prone to this rash. Typically it is seen in people who live in dirty homes with lots of pets (especially cats), according to the doctor I saw. Well, I don't live in a dirty home, or have lots of cats , and you don't have to either. If it is ring-worm the rash should start to fade after a couple days to treatment.

It doesn't look like typical ringworm. The ring is usually more pronounced, whereas these images do not show a ring. It is more likely psoriasis, but I really think a doctor should be consulted, because it really could be any number of things.

Ringworm is not caused by dirty homes, but it is contagious, and can be contracted from animals (pets) as well as humans. Anti fungals such as miconazole and clotrimazole (both are athlete's foot and yeast infection meds) work well for treatment.

Michelle

[Jesse E]

If you scratch it, and dry flakes will come off, leaving a rash with pin-dot bleeding spots, it is pretty much guaranteed to be psoriasis. Why don't you try that and see what happens. If I am wrong, keep looking.

Mind you, even doctors often 'diagnose' psoriasis, even if it is DH.

Hmm nope it doesn't seem to leave a rash or do much of anything when I scratch it.

[Jesse E]

It does look a bit like ringworm according to some pictures I saw on the internet. But of course, it also looks like dermatitis herpetiformis, psoriasis and eczema. Is it just me or do all of these skin conditions look almost identical?

Btw, those are the only 3 spots I have and they're about the size of a quarter each. I had another spot or two on my thighs, but they disappeared a week ago. These new ones are also fading quickly.

The spots look a lot like like the pink healing skin after a scab has fallen off from a scrape. They also seem to have slight yellow center to them and possibly a bump or two in the center.

[Michi8]

It does look a bit like ringworm according to some pictures I saw on the internet. But of course, it also looks like dermatitis herpetiformis, psoriasis and eczema. Is it just me or do all of these skin conditions look almost identical?

It's not just you, and I think drs give incorrect labels a lot due to skin conditions looking similar. You need to see a dr or dermatologist who doesn't just glance at it and give you a quick answer. They need to take your history, and really examine what is going on.

I got a label of eczema years ago, only to find out now that what I had/have was/is probably psoriasis. Now I have to go in to see my dermatologist when I have an active case to confirm. Hard to find the time when I'm run off my feet with my three kids and their health issues too. My suspicion of DH is based on different lesions...but the biopsy (done by a different dermatologist I won't go back to!) was taken from the wrong spot, and so the negative result is really inconclusive.

Michelle

[nikki-uk]

Here's a picture of active DH

Open Original Shared Link

[April in KC]

I think it's possible...but it's a good idea to try treating it as another condition (ringworm, psoriasis) to see if it responds.

Are you very fair-skinned?

I ask because I am very fair, and my DH spots on my elbows (extensor surfaces) does not really look as dark or as bad as many of the pictures of DH I have seen. I have taken photos of it, and it does not look like much other than pink areas that leave behind thickened skin. When it starts, I get anywhere between 1 and 5 bumps per elbow, clustered. In this stage, it is very itchy. Now that I've been gluten free for six weeks, I have scarred areas only; no itching. The skin is really starting to thin back to a normal texture, too. I must have a pretty mild case compared to people who have it stay around for a year or longer. When I got glutened by accident, one little itchy spot showed up on each elbow. I have had the rash off and on since childhood. My parents took me to the pediatrician, who prescribed hydrocortizone cream.

Some people say they get purple scars afterwards; my scars are pinkish (where fading) and dry / white (where only thickened skin remains)...but I finally read an article on DH that said either purplish OR whitish scars were a feature.

If you think you have a problem with gluten, be persistent in figuring it out.

HTH! - April

[Michi8]

I think it's possible...but it's a good idea to try treating it as another condition (ringworm, psoriasis) to see if it responds.

Are you very fair-skinned?

I ask because I am very fair, and my DH spots on my elbows (extensor surfaces) does not really look as dark or as bad as many of the pictures of DH I have seen. I have taken photos of it, and it does not look like much other than pink areas that leave behind thickened skin. When it starts, I get anywhere between 1 and 5 bumps per elbow, clustered. In this stage, it is very itchy. Now that I've been gluten free for six weeks, I have scarred areas only; no itching. The skin is really starting to thin back to a normal texture, too. I must have a pretty mild case compared to people who have it stay around for a year or longer. When I got glutened by accident, one little itchy spot showed up on each elbow. I have had the rash off and on since childhood. My parents took me to the pediatrician, who prescribed hydrocortizone cream.

Some people say they get purple scars afterwards; my scars are pinkish (where fading) and dry / white (where only thickened skin remains)...but I finally read an article on DH that said either purplish OR whitish scars were a feature.

If you think you have a problem with gluten, be persistent in figuring it out.

HTH! - April

April, what you are describing sounds a lot like psoriasis to me (especially with the thickening skin.) My elbows do the same...and that is what the dermatologist said sounds like psoriasis (rather than eczema that I was diagnosed with many years ago.) For some people, their psoriasis gets better with a gluten-free diet.

The "DH" lesions, on me, react differently, and leave dark marks that take a long time to fade (I'm fair-skinned too), but the skin does not thicken. Maybe I'm just all confused now...I've got so many different skin issues going on that I'm not sure what is what anymore.

Michelle

[chrissy]

it looks like nummular excema to me.

[92Aotearoa]

A way to test for DH (to distinguish it from similar afflications) mentioned in older publications is the iodine patch test: a patch wetted with a 50% solution of potassium iodide is applied.

DH is indicated when a blister or lesion forms within one or two days.

I am attempting to get this done myself. Although potassium iodide would appear to be an OTC, it is not readily available, at least without other ingredients.

I tried to get it compounded by a compounding pharmacist but it seems that they say it requires a doctor's prescription (I suspect their lawyers wouldn't let them even compound salt water without one! ) so now I'm working on that. More time and $!

Br J Dermatol. 1980 Sep;103(3):313-7.

"The potassium iodide patch test was studied in twenty-six patients with dermatitis herpetiformis. Histological assessment was found more sensitive than clinical. All of five patients with active disease and not on treatment had a positive test, whereas only two of six patients taking a gluten-free diet (GFD) and one of eight taking dapsone were positive. In another two patients taking a GFD, but in whom the diet had not been strict, the test was positive. All three patients in remission and both patients with the linear pattern of IgA (but with active disease) were negative. Immunofluorescence studies showed no difference in the presence, quantity, or distribution of immunoglobulin, complement or fibrinogen between the patch test site and uninvolved skin, or in the uninvolved skin between patients with and without active lesions."

(I don't have access right now to the full reference but every source I've seen referring to the test specified a 50% potassium iodide solution.)

The lesions resulting from the patch test appear to be the same as spontaneous ones:

Am J Dermatopathol. 1983 Dec;5(6):547-54

"The appearances of biopsy specimens of patch tests with potassium iodide taken from 11 patients with dermatitis herpetiformis and linear or granular IgA disease were similar to those taken from spontaneous lesions."

If you can obtain the potassium iodide solution this might be a simple and inexpensive "prescreening" that might at least point to which type of specialist you should see. Maybe with the references you could get a GP to do it for you.

PS pay attention to "Histological assessment was found more sensitive than clinical"! If you get blister(s) or lesion(s) I would take that as a positive and a stong indication to see someone who specializes in or at least treats a lot of DH. Even if nothing is visible, bear in mind that it might be a case where it's not clinically evident but would have been histologically.

(This is a recurring problem in medical diagnosis: many of us patients get stuck in a gray area of uncertain results and it can sometimes take a lot of time, patience, dollars and _luck_ (in finally finding the right doctor) to get out of it.

Best of luck!

Jim

[finally diagnosed]

I took these pics of this weird rash on my abdomen:

Potential Dermatitis Herpetiformis 1

Potential Dermatitis Herpetiformis 2

Potential Dermatitis Herpetiformis 3

It's itchy and seemed to appear out of nowhere.

I have major digestion problems when eating gluten, but have never been officially diagnosed with celiac.

Does this look like dermatitis herpetiformis to you guys?

Hi , I hope this reply goes through. I gotta tell ya, I have the same rash on both my upper arms. they just appear out of know where and are really itchy. I have had it my whole adult life off and on. I thought at first it was dry skin, but I am very loyal to lotion daily. For me it seems to just appear during the worst times. I use to just hide it with long sleeves but I just deal with it. If the itching gets bad I will use benadryl cream if desperate. but I was always told it was nothing, but that was before I was diagnosed with celiac. I think stress has alot to do with it for me. When things slow down for me, I notice it just seems to go away. Good Luck, Lorrie : )

[trishaz]

April, what you are describing sounds a lot like psoriasis to me (especially with the thickening skin.) My elbows do the same...and that is what the dermatologist said sounds like psoriasis (rather than eczema that I was diagnosed with many years ago.) For some people, their psoriasis gets better with a gluten-free diet.

The "DH" lesions, on me, react differently, and leave dark marks that take a long time to fade (I'm fair-skinned too), but the skin does not thicken. Maybe I'm just all confused now...I've got so many different skin issues going on that I'm not sure what is what anymore.

Michelle