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Dermatitis Herpetiformis
Also indexed as: Duhring’s Disease, Herpes circinatus bullosus
This rare but serious food allergy can cause uncomfortable rashes. According to research or other evidence, the following self-care steps may help you manage dermatitis herpetiformis:
- Get extra antioxidants
- Take a daily supplement containing 10 IU of vitamin E and 200 mcg of selenium to prevent a common deficiency linked to DH
- Give up gluten
- To avoid the allergic reaction that causes DH, eat a diet free of wheat, rye, and barley
- Take a test
- Visit your healthcare provider regularly for blood tests that can determine if you are developing nutritional deficiencies caused by malabsorption related to DH
These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full dermatitis herpetiformis article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.
About dermatitis herpetiformis
Dermatitis herpetiformis (DH) is a chronic disease of the skin that may occur in people of any age, but is most common in the second to fourth decades of life.1
Product ratings for dermatitis herpetiformis
| Science Ratings | Nutritional Supplements | Herbs |
|---|---|---|
 |
Selenium Vitamin E |
|
 |
Betaine HCl Folic acid (if deficient) Iron (if deficient) Multiple vitamin-mineral PABA Vitamin B12 (if deficient) Vitamin B3 (nicotinamide, when combined with tetracycline) Zinc (if deficient) |
|
 Reliable
and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies
suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal
or no scientific evidence. For a supplement, little scientific support and/or minimal health
benefit. |
||
What are the symptoms?
DH is characterized by intensely itchy hives or blister-like patches of skin located primarily on elbows, knees, and buttocks, although other sites may be involved. A burning or stinging sensation may accompany the itching.
Dietary changes that may be helpful
The cause of DH is mainly an allergic reaction (called hypersensitivity) to foods (wheat and other grains) containing a protein called gluten. People with DH are usually found to have abnormalities of the intestinal lining identical to that of celiac disease (also called gluten-sensitive enteropathy or celiac sprue),2 a serious intestinal disorder also due to gluten sensitivity. Unlike celiac disease however, gastrointestinal symptoms may be mild or absent in DH.3 4 5 6
Strict adherence to a lifelong gluten-free diet (GFD) can eliminate symptoms of DH and the intestinal abnormalities, as well as reduce or eliminate the need for medication in most people. However, an average of 8 to 12 months of dietary restriction may be necessary before symptoms resolve.7 8 9 10 11 12 13 14 15
An increased incidence of lymphoma (cancer of the lymph tissue),16 17 18 and certain autoimmune and connective tissue disorders19 20 have also been reported in DH. Preliminary studies suggest a strict GFD of at least five years’ duration may reduce the increased risk of developing lymphoma in DH.21 22 23
Not all people with DH improve on a GFD and/or medication. Preliminary studies indicate sensitivity to other dietary proteins may be involved.24 25 26 Some practitioners would recommend an elimination diet and/or allergy testing to check for other food sensitivities.
A milk-free diet may improve symptoms of dermatitis herpetiformis, according to uncontrolled preliminary reports. In these reports, intake of milk products intensified symptoms of DH in two patients despite adherence to a gluten-free diet. The combination of a milk-free and gluten-free diet was effective, however.27 28
Other therapies
Strict adherence to a gluten-free diet is essential.
Vitamins that may be helpful
People with DH frequently have mild malabsorption (difficulty absorbing certain nutrients) associated with low stomach acid (hypochlorhydria) and inflammation of the stomach lining (atrophic gastritis).29 Mild malabsorption may result in anemia30 and nutritional deficiencies of iron, folic acid,31 32 vitamin B12,33 34 and zinc.35 36 37 More severe malabsorption may result in loss of bone mass.38 Additional subtle deficiencies of vitamins and minerals are possible, but have not been investigated. Therefore, some doctors recommend people with DH have their nutritional status checked regularly with laboratory studies. These doctors may also recommend multivitamin-mineral supplements and, to correct the low stomach acid, supplemental betaine HCl (a source of hydrochloric acid).
Para-aminobenzoic acid (PABA) in high amounts (9–24 grams per day) has been reported to reduce or eliminate the skin lesions of DH in one preliminary, clinical trial.39 With continued administration, people with DH remained symptom-free for as long as 30 months. Since supplementation with such large amounts of PABA has the potential to cause side effects, these amounts should be used only with medical supervision.
A deficiency in the selenium-containing antioxidant enzyme known as glutathione peroxidase has been reported in DH.40 41 Preliminary42 and double-blind43 trials suggest that supplementation with 10 IU of vitamin E and 200 mcg of selenium per day for six to eight weeks corrected this deficiency but did not lead to symptom improvement in the double-blind trial.
There is preliminary evidence that, when drug therapy with dapsone is not tolerated, people with DH may respond to a combination of the antibiotic, tetracycline, and nicotinamide (a form of vitamin B3).44 45 However, this course of treatment should only be tried under the supervision of a physician.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
References
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.