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Celiac Rash: Could Gluten Be The Cause Of Your Adverse Skin Conditions?

When you think about the symptoms of celiac disease, nagging gastrointestinal concerns like bloating and diarrhea are probably the first thing to come to mind. 

However, for some people, celiac disease causes an itchy, blistering rash known as dermatitis herpetiformis or celiac rash. 

Learning how to visually identify celiac rash is crucial for early diagnosis and management of both celiac rash and celiac disease. We’ll take you through the symptoms of celiac rash, share celiac rash pictures, and discuss treatment for celiac rash. 

What is Celiac Disease?

Celiac disease is an autoimmune condition that is triggered by the ingestion of gluten, a protein found in grains like wheat, barley, and rye. Gluten proteins trigger inflammation in the intestinal tract and other parts of the body. This systemic inflammation can then contribute to the development of autoimmune disease and a host of other health issues.

Celiac disease is typically associated with gastrointestinal symptoms, but the truth is, celiac disease can affect many other systems in the body. We discuss different symptoms in depth in this article, and some of the key symptoms of celiac disease include the following: 

Symptoms of non-celiac gluten sensitivity are similar to those associated with celiac disease.

What is Celiac Rash?

Celiac rash, also called Dermatitis Herpetiformis, is an extraintestinal manifestation of gluten exposure. In other words, celiac rash is a symptom of celiac disease that happens outside of the intestines.

Dermatitis Herpetiformis causes skin lesions like papules (a small solid or cystic raised spot on the skin) and vesicles (a small fluid filled sac or cyst) typically on the elbows, knees, and buttocks. These lesions tend to cause intense itching and discomfort. While it can happen in children, dermatitis herpetiformis affects mostly adults, the mean age at onset is about 50 years.

Celiac Rash Pictures

Dermatitis herpetiformis. Typical scratched papules and macules on the elbows (A), and on the knees (B). Fresh small blisters on the elbow (C). Direct immunofluorescence showing granular IgA deposits in the basal membrane zone between epidermis and dermis (D).

Source: Reunala T, Salmi T, Hervonen K, Kaukinen K, Collin P. Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease. Nutrients. 2018;10(5):602. doi:https://doi.org/10.3390/nu10050602.
Clinical presentation of dermatitis herpetiformis (DH) on the buttocks: erythematous grouped papules and vesicles.

Source: Nguyen CN, Kim SJ. Dermatitis Herpetiformis: An Update on Diagnosis, Disease Monitoring, and Management. Medicina. 2021;57(8):843. doi:https://doi.org/10.3390/medicina570808432.

Misdiagnosis and Similar Skin Conditions

It can be easy to misdiagnose celiac rash as another skin condition. This is because many people do not expect celiac disease to cause skin-related symptoms. In addition, celiac rash can look similar to other skin conditions, like eczema and psoriasis. 

Eczema

Like dermatitis herpetiformis, eczema can lead to an intensely itchy rash on the elbows and legs. However, unlike dermatitis herpetiformis, eczema also causes dry, flaky, and sometimes thickened patches of skin. Eczema may also cause the skin to be either lighter or darker than the usual skin tone for several months after a rash heals, whereas dermatitis herpetiformis typically heals without scars or other skin changes.

Psoriasis

In psoriasis, inflammation causes certain skin cells to grow too fast. This causes cells to pile up and form very thick, itchy patches, called plaques.

While these conditions can look different, research has suggested a link between celiac disease and psoriasis, one study demonstrated an approximately 3-fold increased risk of celiac disease among patients with psoriasis. If diagnosed with either condition, it is worth exploring whether you might have the other condition.

Treatment Options for Celiac Rash

A gluten free diet is an absolute necessity for people who are experiencing celiac rash. It is important to be sure that you are following a true gluten free diet that eliminates all forms of gluten, not just the most commonly recognized forms of gluten. A traditional gluten free diet does not eliminate all forms of gluten and may not provide full relief from celiac rash. Let’s take a quick look at the main differences between the traditional gluten free diet and the true gluten free diet.

Traditional gluten free diet

The traditional gluten free diet restricts wheat, barley, and rye as sources of gluten from the diet. Those following the traditional gluten free diet often find themselves consuming lots of processed gluten free foods made with alternative refined grains, inflammatory gums and stabilizers, sugars or sweeteners, and other artificial colors or flavors. These foods are largely comprised of corn, rice, and/or oats. They are highly processed, and contain large amounts of carbohydrate calories, but very low quantities of vitamins and minerals.

True gluten free diet

Since gluten is a mixture of proteins found in ALL grains, a true gluten free diet excludes ALL grains. This might seem contrary to mainstream advice, but the reality is, only a few types of gluten proteins ( alpha gliadin, found in wheat, secalin found in rye, and hordein found in barley) have been studied extensively. The labeling laws around gluten are based on these forms of gluten protein, but fail to recognize all other forms of gluten.

There are additional types of gluten proteins found in other grains. There is a growing body of research that shows that grains like oats, corn, and rice do actually cause inflammatory damage to those with celiac and gluten sensitivity.  

Medication for symptom relief

Medications do exist to support celiac rash. Research acknowledges that drugs such as dapsone, other sulfonamides, or steroids can be useful as “short-term additive treatments until diet alone is adequate.”

That line has some important points. First, medications are intended to be short term. The ultimate goal is for diet alone to be sufficient to eliminate symptoms. Second, medications are intended to be additive. This means that it is important to combine any medication use with a true gluten free diet. While medications may alleviate symptoms, they do not address the root cause of the problem. 

The use of medication to cover symptoms without making a diet change has the potential to be quite dangerous. This is because research has suggested that continued gluten consumption in celiacs can increase the risk of other diseases, and even premature death, for celiac patients.

Conclusion

The symptoms of celiac disease extend far beyond gastrointestinal concerns. One of the most common extraintestinal symptoms of celiac disease is celiac rash, or dermatitis herpetiformis. It is important to learn how to identify and treat celiac rash and celiac disease so that you can properly heal and recover.

Want to learn more and explore whether or not you have a gluten sensitivity? Take the Gluten Sensitivity Quiz!

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