Dermatitis Herpetiformis
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Dermatitis herpetiformis is a rare skin disorder associated with coeliac disease. The name herpetiformis refers to the fact that the rash often resembles the rash caused by herpes zoster (shingles and chickenpox).


  •  Adulthood (20-40)
  •  Coeliac’s disease (transglutaminase)
  •  M:F 2:1


  • Deposition of  IgA in papillary dermis causing an immunological cascade
  • Is an immunologic response to chronic stimulation of the gut mucosa. IgA react to gluten-tissue transglutaminase (t-TG) in the gut, and epidermal transglutaminase (e-TG).
  • Genetic predisposition with HLA expression (10% have affected relative)

Signs & Symptoms

  • Suicidally itchy’ blisters and papules. Intensely pruritic
  • Often few blisters as most are scratched and therefore appear as papules
  • Intermittent cutaneous lesions mainly affecting the buttocks, knees and elbows
  • Rraely any bowel symptoms of coeliac’s disease
Dermatitis Herpetiformis rash on abdomen
Dermatitis Herpetiformis rash on abdomen


Gluten free diet for life to control symptoms and reduce risk of small bowel lymphoma.
Other agents can help to get the rash under control, but will typically not have any benefit for the underlying bowel disease. These may include:
  • Dapsone (antibacterial) – 50mg once daily
  • Sulphapyridine (sulphonamide ABx)
  • Betamethasone 0.05% – a potent topical steroid


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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