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A Couple Quick Questions


BRUMI1968

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BRUMI1968 Collaborator

I have Celiac disease, but no DH. My stepdad has just been diagnosed with DH.

1. does this mean he has celiac, or can DH be separate from that?

2. is it like celiac in that a molecule of gluten can cause reaction?

Thanks, guys. I need to do some research on DH so that I can help him cope. He's probably not going to do the diet in any complete way, but I suppose getting him on the right track might help. Thanks.


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happygirl Collaborator

From Dr. Green's page: Open Original Shared Link

"What is dermatitis herpetiformis (DH)?

DH is an intensely itchy vesicular rash occurring anywhere on the body, especially on the extensor surfaces (knees and elbows) and the scalp. Patients tend to experience the rash in the same area, for example on their hands, in their scalp or on the buttocks. Virtually 100% of patients with DH have celiac disease, though the intestinal lesion is usually milder than most patients who have predominantly gastrointestinal complaints. The lesions of DH are very sensitive to even the ingestion of small amounts of gluten. Other dietary factors, for example iodine, may exacerbate the rash or prevent its healing. The rash is however dependant on the ingestion of gluten. While Dapsone will control the skin lesions of DH, a gluten-free diet allows Dapsone to be discontinued, healing of the intestine and reduction in the risk of the development of lymphoma that is increased in patients with DH."

and Open Original Shared Link

"What is dermatitis herpetiformis?

Dermatitis herpetiformis (DH) is the skin manifestation of celiac disease. All patients with DH have celiac disease. It is an intensely itchy rash that usually occurs in the same place for each patient. This may be on the hands or fingers, forearms, buttocks or scalp or anywhere on the body. The rash typically consists of very itchy, small red dots that may develop into blisters or pimples. They are intensely itchy.

The diagnosis is clinical and can be confirmed by biopsy. The biopsy, for best results, needs to be taken from just adjacent to a lesion. The biopsy needs to have special immunofluorescence tests performed on it.

Treatment is first and foremost a gluten-free diet. This results in resolution of the lesions and will prevent new lesions. The diet also will prevent the development of lymphoma, that occurs at an increased rate as in patients with celiac disease. Drugs (Dapsone) may help patients recover from a severe episode, but are not a substitute for the diet. Patients with DH are very sensitive to small amounts of gluten."

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    • Scott Adams
      You've done an excellent job of meticulously tracking the rash's unpredictable behavior, from its symmetrical spread and stubborn scabbing to the potential triggers you've identified, like the asthma medication and dietary changes. It's particularly telling that the rash seems to flare with wheat consumption, even though your initial blood test was negative—as you've noted, being off wheat before a test can sometimes lead to a false negative, and your description of the other symptoms—joint pain, brain fog, stomach issues—is very compelling. The symmetry of the rash is a crucial detail that often points toward an internal cause, such as an autoimmune response or a systemic reaction, rather than just an external irritant like a plant or mites. I hope your doctor tomorrow takes the time to listen carefully to all of this evidence you've gathered and works with you to find some real answers and effective relief. Don't be discouraged if the rash fluctuates; your detailed history is the most valuable tool you have for getting an accurate diagnosis.
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    • trents
      Welcome to the forum, @catsrlife! Celiac disease can be diagnosed without committing to a full-blown "gluten challenge" if you get a skin biopsy done during an active outbreak of dermatitis herpetiformis, assuming that is what is causing the rash. There is no other known cause for dermatitis herpetiformis so it is definitive for celiac disease. You would need to find a dermatologist who is familiar with doing the biopsy correctly, however. The samples need to be taken next to the pustules, not on them . . . a mistake many dermatologists make when biopsying for dermatitis herpetiformis. 
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