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The Pastore Podcast

Feb 28, 2020

Dr. Pastore discusses Dermatitis Herpetiformis - an autoimmune condition with skin rashes that is caused by the consumption of gluten.


He covers who is most at risk, what this autoimmune condition is, how to get properly diagnosed and the celiac disease connection.




Dermatitis Herpetiformis (DH) is NOT the same as celiac disease. The majority of those with DH also have celiac disease, however there are people that only have DH and not celiac disease, and vice versa.


DH is an autoimmune reaction where antibodies (IgA) are formed after the consumption of gluten, which travels in bloodstream and are deposited in skin. This signals a reaction that creates itchy/blistering skin or bumps, resembles herpes-like lesions.


DH is misdiagnosed 95% of the time for eczema.


The prominent sign that it is DH and not eczema is that rashes will occur on both sides of body - typically around the knees, scalp, buttocks, elbows. 


DH is diagnosed via skin biopsy, as 20% of patients have normal blood and intestine testing for celiac. Most have no gastrointestinal issues.


If you or a relative had Hashimoto’s thyroiditis, Grave’s disease, Celiac disease, type 1 diabetes,  lupus, or Sjogren's syndrome and you have eczema-like rash, speak to your doctor about a skin biopsy.


Misdiagnosed DH patients that are prescribed Prednisone/topical corticosteroids creams can mask symptoms temporarily, then cause a rebound flare-up.


Consuming other food intolerances (besides gluten) can make DH worse.


A gluten free diet combined with the antibiotic dapsone (topical or orally) is the common treatment for DH. It can take up to 2 years for full skin recovery.


Iodine and Nonsteroidal anti-inflammatory drugs (NSAIDs) can also cause or worsen flares. Iodine is found in: cough medicine, iodized salt, shellfish, seaweed/kelp/nori, yogurt, milk, and iodine supplements.