An estimated 1.8 million Americans have celiac disease, but an alarming number of them remain undiagnosed. Celiac disease is often difficult to diagnose because the symptoms take time to develop and often mimic the symptoms of other conditions, particularly digestive disorders.
One of the lesser known symptoms of celiac disease that can be quite severe is dermatitis herpetiformis, also known as a “gluten rash”. This condition affects roughly 17% of celiac disease sufferers and, in many cases, occurs in people who do not experience digestive symptoms.
In this article, we’ll cover the subject of gluten rash including what it is, how to treat it, and how to manage your symptoms with a gluten free diet.
What is the Gluten Rash?
The term gluten rash is frequently used in reference to a skin condition called dermatitis herpetiformis.
This condition is identified physically by an itchy, blistering skin rash that most commonly occurs in patients with celiac disease. The rash is triggered by the consumption of gluten, a protein found in certain grains including wheat, barley, and rye. Since celiac disease is an autoimmune condition in which the immune system mistakenly attacks the cells in the small intestine, in some, it also attacks the skin.
Interestingly, this rash seems to be more common in men than women. Some studies show a male-to-female ratio of nearly two-to-one.
While this affects less than 25% of patients with celiac disease, for those who have it, it is a strong diagnostic indicator of the disease. It can also develop in patients who do not adhere strictly enough to their gluten free diet.
What Does Gluten Rash Look Like?
Dermatitis herpetiformis can occur anywhere on the body, but it is most commonly seen on the knees, elbows, buttocks, lower back, and the back of the neck. The rash typically takes the form of myriad tiny reddish-purple bumps that can take several days to heal. Once they are healed, however, they may still leave behind purple marks that can last for weeks or months at a time. In very severe cases of gluten rash, patients may develop lesions topped with clear, fluid-filled blisters. Because the condition is extremely itchy and force people to scratch, these blisters are prone to popping.
In most cases, the rash develops in a symmetrical way. This simply means that if you develop the rash on one side of your lower back, you will likely develop it on the other side as well. Just because the rash isn’t symmetrical, however, doesn’t rule out the possibility of dermatitis herpetiformis. Diagnosis is often made with a skin biopsy that is used to look for certain antibodies beneath the skin. This is usually an in-office procedure that only requires a small skin sample.
In addition to a skin biopsy, blood tests can be used to support a diagnosis of celiac disease. These tests are used to identify antiendomysial or anti-tissue transglutaminase antibodies, but it should be noted that they will only be present in celiac sufferers currently eating gluten – these tests will become negative with prolonged adherence to a diet free from gluten.
How Do You Treat Gluten Rash?
Some celiac patients who have dermatitis herpetiformis also have digestive symptoms. Though the existence of this rash is a strong indicator of celiac disease in patients without digestive symptoms, it can also be caused by other conditions such as psoriasis, eczema, and hives. In fact, there are several skin conditions which are linked to celiac disease including eczema and psoriasis.
The only long-term treatment for gluten rash is strict adherence to a gluten free diet. Because celiac disease is currently an incurable condition, patients who experience gluten rash can hope to be free from their symptoms at some point, but any exposure to gluten has the potential to trigger a flare-up. In fact, skin-related symptoms of celiac disease are much easier to trigger than digestive issues. Even very small exposures to gluten can trigger a flare-up in celiac patients prone to gluten rash.
Tips for Managing Symptoms with a Gluten Free Diet
Because managing skin-related symptoms of celiac disease can be tougher than mitigating digestive symptoms, you need to be extra cautious with what you eat. When purchasing packaged gluten free foods, make sure they are produced in a dedicated gluten free facility to avoid cross-contamination. Brands like Schär offer a wide variety of options to help you easily manage your gluten free lifestyle.
Here are some other tips for managing gluten rash symptoms:
- Be as strict as you possibly can with the gluten free diet – even a small exposure can trigger symptoms that may take days to subside.
- Avoid the temptation to cheat on your diet – it can take years of strict gluten free eating for symptoms to completely disappear, though your reactions may lessen over time.
- Take every precaution you can against cross-contamination including keeping gluten free foods, utensils, and food prep equipment completely separate.
- Be particularly careful of naturally gluten free grains like rice and oats because they can still be processed on shared equipment with gluten-containing grains like wheat.
- Be careful when eating out. Always look ahead to see if the menu has gluten free options and, even if they do, there is a risk of cross-contamination. Don’t be afraid to educate the restaurant staff about your specific dietary needs.
Recovering from gluten rash can take time. Fortunately, the stricter you are with the gluten free diet, the sooner you’re likely to see your flares becoming less severe. Eventually, the rash itself may go away, but you may develop itching in the areas where you used to have the rash if you happen to be glutened again. If you really want relief from gluten rash symptoms, a strict gluten free diet is the best option.
