Dermatitis Herpetiformis: An Update on Diagnosis and Management

Timo Reunala, Kaisa Hervonen, Teea Salmi

    Research output: Contribution to journalReview Articlepeer-review

    48 Citations (Scopus)
    13 Downloads (Pure)


    Dermatitis herpetiformis (DH), presenting with an intense itch and blistering symmetrical rash, typically on the elbows, knees, and buttocks, is a cutaneous manifestation of celiac disease. Though overt gastrointestinal symptoms are rare, three-fourths of patients with DH have villous atrophy in the small bowel, and the rest have celiac-type inflammatory changes. DH affects mostly adults and slightly more males than females. The mean age at onset is about 50 years. DH diagnosis is confirmed by showing granular immunoglobulin A deposits in the papillary dermis. The DH autoantigen, transglutaminase 3, is deposited at the same site in tightly bound immune complexes. At present, the DH-to-celiac disease prevalence is 1:8. The incidence of DH is decreasing, whereas that of celiac disease is increasing, probably because of improved diagnostics. In DH, the treatment of choice for all patients is a gluten-free diet (GFD) in which uncontaminated oats are allowed. At onset, most patients need additional dapsone to rapidly control the rash and itching. Dapsone can be stopped after a mean of 2 years, and a strict lifelong GFD alone is required. Dietary adherence offers an excellent long-term prognosis for patients with DH, with a normal quality of life and all-cause mortality.

    Original languageEnglish
    Pages (from-to)329–338
    Publication statusPublished - 2021
    Publication typeA2 Review article in a scientific journal

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • Dermatology


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