Dermatitis Herpetiformis

Natalia Plotnikova, BS; Jami L. Miller, MD


Skin Therapy Letter. 2013;18(3) 

In This Article

Abstract and Introduction


Dermatitis herpetiformis (DH) is an autoimmune, pleiomorphic, papulovesicular disorder associated with celiac disease and gluten sensitivity. DH is characterized by subepidermal bullae on hematoxylin and eosin staining and granular immunoglobulin A deposits in the dermal papillae using the direct immunofluorescence method. Antibodies to tissue transglutaminase and epidermal transgulatminase can be measured serologically, although biopsy is still required for definitive diagnosis of DH. Gluten free diet (GFD) is the first-line therapeutic approach that can alleviate both cutaneous and intestinal manifestations of this condition, while dapsone and sulfones target the skin eruption only. Combined therapy with GFD and dapsone is an initial treatment of choice to control the cutaneous manifestations of DH. This article will provide a comprehensive review of DH, including its epidemiology, clinical and pathological findings, diagnostic evaluation, and management.


Dermatitis herpetiformis (DH), a cutaneous manifestation of celiac disease (CD), was first described by Louis Adolphus Duhring in 1884.[1] DH is a chronic, polymorphous, pruritic skin disease with a male predominance of 1.44:1 to 2:1 that generally presents in the fourth decade, although it has been reported in patients as young as 2 and as old as 90 years of age.[2,3] DH is most common in Caucasians of northern European descent with a prevalence of 11.2 and an incidence of 0.98% per 100,000 people.[2] Cutaneous manifestations include grouped papulovesicles on an erythematous base with excoriations, crusts, and occasional lichenification due to scratching. Symmetric distribution on the extensor surfaces of the elbows and knees, back, scalp (often posterior hairline) and buttocks is most common (Figure 1). Less often, purpura can be present on fingers and toes.[4]

Figure 1.

Symmetric excoriated papules on the lower back.