What Is a Celiac Disease Rash?

If you have celiac disease, your body is intolerant to gluten, a protein naturally found in wheat, barley, rye, and triticale. With celiac disease, consuming gluten can damage the small intestine.

However, gut-related changes aren't the only symptoms of celiac disease. In some people with celiac disease, a rash may be one of the most common symptoms of gluten intolerance. 

What Is Celiac Disease?

Celiac disease is a chronic autoimmune disease in which gluten signals the body to attack the small intestine.

A wide range of symptoms, including rashes, can affect virtually every body part. Some common celiac disease symptoms include:

• Bloating
• Gas
• Chronic diarrhea
• Constipation
• Nausea or vomiting
• Pain in the abdomen

Celiac disease symptoms that affect other body parts include:

• Dermatitis herpetiformis (DH), also known as a celiac disease rash
• Fatigue
• Joint or bone pain
• Depression or anxiety
• Headaches or seizures
• Fertility problems

Still, celiac disease can be hard to identify since the illness causes various symptoms that can come and go. In fact, many people—up to 83% of people in the United States—with celiac disease remain undiagnosed or misdiagnosed.

What Is a Celiac Disease Rash?

DH affects as many as 15% of people with celiac disease. The rash develops from consuming, rather than touching, gluten and most often develops in adults aged 30–40. 

"Most people do not think this is [celiac disease]. Instead of gluten triggering an inflammatory response in the gut, it triggers this response in the skin," Salvatore Alesci, MD, PhD, chief scientist and strategy officer at Beyond Celiac, told Health. "If you have the dermatitis herpetiformis rash, you have celiac disease. Period. You do not need to have any gastrointestinal symptoms."

What Does Celiac Disease Rash Feel and Look Like?

With DH, people may experience a burning sensation before any lesions appear. Additionally, other features of DH include:

• Itchy bumps or blisters that appear symmetrically on both sides of the body in the elbows, knees, face, scalp, back, groin, and anal region
• Scratch marks or skin erosions, which are shallow skin lesions
• Dental enamel problems, such as teeth discoloration, or oral lesions, like canker sores

However, just like diagnosing celiac disease can be hard, identifying celiac disease rash can be tough. The blistering lesions look similar to herpes, which can lead to a misdiagnosis. In fact, one of the root words of dermatitis herpetiformis is "herpes." Although the conditions present very similarly, DH is unrelated to the herpes virus.

People with DH may scratch so hard that they remove these lesions with their nails, making the rash look different.

"Because dermatitis herpetiformis is so itchy, it can frequently be misdiagnosed as eczema, especially if someone comes in after they popped and scratched off the blisters," Amy Burkhart, MD, an integrative medicine physician and registered dietitian who specializes in gut health, told Health.

If typical treatments for those eczema or other skin conditions aren't working, ask for a referral to a dermatologist, advised Dr. Burkhart. Dermatologists are experts in the skin and can help diagnose and treat DH.

Also, if you have a rash, teeth discoloration, or frequent cavities, ask your dermatologist if your rash could possibly link to celiac disease.

How Is a Celiac Disease Rash Diagnosed?

If a dermatologist suspects DH, they will need to take a skin biopsy next to the lesion to accurately diagnose the condition.

If you have DH, the dermatologist will find IgA antibody deposits from the biopsy. IgA antibodies are one of the most common antibodies in the body. However, people with autoimmune diseases, like celiac disease, often have more IgA antibodies than normal.

Also, while you may not need an intestinal biopsy, some healthcare providers recommend one, said Dr. Alesci.

Of note, diagnosing DH in children is not always easy. Children may not display typical DH symptoms, which may co-occur with eczema symptoms.

Treatments for Celiac Disease Rash

DH symptoms can be stubborn. A strict gluten-free diet is the only treatment for the underlying disease. 

"Patients need to be on a strict gluten-free diet for two years," explained Dr. Alesci. In some cases, DH symptoms may take as long as two years to clear.

A gluten-free diet eases symptoms much quicker for people with celiac disease who don't have DH symptoms than those with the rash. Even with a gluten-free diet, people with DH may need medication for several months to two years.

In the meantime, other remedies can relieve the rash's itchiness and burning. A healthcare provider will likely prescribe dapsone, an oral antibiotic and anti-inflammatory, that can alleviate symptoms. Sometimes, you may need to take dapsone for one or two years, according to Dr. Alesci.

Dapsone can cause side effects, including hemolytic anemia, when the body destroys red blood cells faster than they make them. If you have side effects from dapsone, a healthcare provider may prescribe alternative medications, including sulfapyridine (an antibiotic) or sulfasalazine (a disease-modifying anti-rheumatic drug).

Also, if dapsone doesn't work, a topical hydrocortisone or lidocaine cream for relief may help, said Dr. Burkhart.

In contrast, you may want to avoid taking an oatmeal bath, a common skin-soothing treatment. Even if touching gluten doesn't trigger the rash, staying away from oatmeal soaks may be best, according to Dr. Burkhart.

You'll also want to practice gentle skincare—such as taking short, cool showers—to promote skin barrier repair and function.

Without treatment, potential complications of DH include autoimmune thyroid disease and the development of certain cancers.

How To Prevent Celiac Disease Rash

The goal is to eventually stop medication once the rash disappears. But you'll still need to stay gluten-free to prevent future flares. A gluten-free diet will not only clear up the rash long-term but also prevent damage to the small intestines.

DH relapses are common, according to Dr. Alesci. Although, DH can go into remission, where lesions are not present for two years or more without treatment or avoiding gluten. However, while a gluten-free diet decreases the risk of DH returning, it's not a guarantee.

Still, in some cases, even without treatment, DH can disappear seemingly at random. Though, it's unclear why that happens. 

For some people, a high-iodine diet may trigger flares of DH, noted Dr. Burkhart. If that's the case, a healthcare provider or a registered nutritionist dietitian may advise avoiding iodine-rich foods, such as seaweed, cod, shrimp, yogurt, milk, and iodized salt.

A Quick Review

If you have celiac disease, the condition may manifest as a rash, also known as DH. The rash comes with itchy bumps and blisters and can sometimes feel burning. If a healthcare provider suspects DH, they will biopsy a patch of your skin to confirm the diagnosis.

A gluten-free diet can help with DH. However, medication may be necessary to treat the rash and get relief from the itchiness.