Can Gluten Cause Hives & Other Skin Rashes?

That skin rash that won’t go away – it’s entirely possible it is a form of Celiac disease.

You may call it hives, a rash, or simply itchy skin, and it does not go away. Steroid creams may help the itchiness but they do not solve the problem.

That’s because the rash may be Celiac disease in disguise.

Known as dermatitis herpetiformis, DH or Duhring’s disease, this rash is the skin version of Celiac disease and non-Celiac gluten sensitivity. And of the 300,000 Canadians diagnosed with Celiac disease, more than 10% suffer from this gluten related rash.

This rash from Celiac disease rarely affects children and is almost twice as likely to occur in men than in women. (1)

To make diagnosis more difficult, people who suffer from a gluten allergy skin rash often do not have any gut issues. One study showed that 20% of those with a Celiac rash had completely normal digestive tracts! (2)

Why does gluten intolerance cause a rash?

A Celiac rash is a chronic recurrent disease. The main symptom is a very itchy rash. In medical lingo, the rash is called a papulovesicular pruriginous rash, however you may call it hives, a rash, or simply itchy skin. This particular skin condition does not go away.

The exact cause of this Celiac rash has yet to be discovered, however we know:

• You need to be genetically susceptible;
• You need to have ingested gluten for a long period of time.

Aside from this, we have much to learn. Recent research suggests that certain enzymes may play a role. In Celiac disease, the enzyme tTG (tissue transglutaminase) alters the appearance of a gluten protein which triggers the attack by the immune system.

When you suffer a rash from Celiac disease, tTG plays a role as does the the enzyme ETG (epidermal transglutaminase). This enzyme is released into the bloodstream and deposited on the skin. The immune system then mistakes it for a foreign invader and attacks. (2)

How is this rash diagnosed? 

Proper diagnosis of this gluten related rash is trickier than diagnosing Celiac disease as there currently isn’t a blood test. Instead, diagnosis relies on a skin biopsy. The biopsy must be done on healthy skin. Skin that is reacting may result in a misdiagnosis for other skin conditions.

In Celiac disease with gut related symptoms, a biopsy of the small intestine is usually performed to confirm the diagnosis. However, unless there are GI symptoms accompanying the rash, a small intestine biopsy isn’t needed.

If you have a positive diagnosis of DH, you have Celiac disease.

I can’t stress this point enough. Even though you may not have any other symptoms commonly associated with Celiac disease, a diagnosis of DH (dermatitis herpetiformis or Duhring’s disease) means your body cannot ingest gluten.

The only cure? Eating a gluten-free diet.

Celiac disease is caused by ingesting gluten. Consuming gluten triggers the immune system to attack the GI tract. This results in symptoms like bloating, stomach pain and diarrhea.

The rash known as DH is also caused by ingesting gluten, but instead of GI symptoms the body responds with an itchy skin rash. (2)

This means even if you don’t have any of the common symptoms (diarrhea, bloating, constipation) of Celiac disease, if you have DH you have Celiac disease. 

The Celiac rash is found more often on the elbows and knees, however it can occur anywhere on the body. And if you’ve ever had DH before, you know just how itchy can be. Often, it is scratched at until it bleeds or even scars. The intense itchiness can even contribute to a lack of sleep and a decreased ability to focus. In the 19th century, before itch-alleviating medications were developed, this gluten related rash was reported as a cause of suicide.

Can you eat a little gluten if you have DH?

Absolutely not. Remember, DH is another form of Celiac disease. The only way to effectively treat Celiac disease is only eating a gluten-free diet. 

Check out my crash course on going gluten free.

In Celiac disease, a gluten exposure is likely to cause symptoms for 1-2 days. In DH, a single gluten exposure can cause symptoms for weeks. If you’re just starting a gluten-free diet, be patient. You may not notice any change in symptoms for months. To further complicate the issue, your skin may continue to react for more than two years after starting a gluten-free diet. (3) This makes it possible to get flare-ups or outbreaks even without a recent exposure to gluten.

Most individuals get diagnosed with DH in their 30s or 40s. That means the average person has likely consumed wheat products for more than three decades. Be patient – it can take a year or more for symptoms to improve. Even though you may still be suffering symptoms, stick to a gluten-free diet for the long term. Eating gluten free is the only cure for DH.

Causes of DH other than gluten

To further complicate treatment of DH, gluten is not the only possible trigger. The following substances can trigger DH or make it worse:

• Iodine
  • Exposure to iodine can trigger a Celiac rash. (4) 
  • If your skin is not improving after adhering to a strict gluten-free diet, look at possible iodine sources in your diet. This includes:
    • Iodized salt
    • Iodine supplements
    • Seaweeds
    • Seafoods
• NSAIDs
  • Non-steroidal anti-inflammatory drugs can aggravate skin lesions. (5)
  • Those with DH should take acetaminophen (Tylenol) for aches and pains.
• Skin creams and hair products
  • The skin does not absorb gluten. However many self-care products contain gluten and can be accidentally consumed – like lip balms and lipsticks.
  • Some skin creams may cause a rash simply because the skin suffering from DH is already irritated.
• Stress
  • There is no study citing a clear link between stress and DH. However, many patients with DH have linked increases in stress levels with outbreaks in their skin.

How do you treat this gluten rash?

To help with symptoms your doctor can prescribe the following medications:

• Dapsone (sulfapyridine)
  • Dapsone blocks the inflammatory process from happening in your skin. However, the decrease in itching provided by dapsone does not mean the disease is cured. Dapsone does not replace a gluten-free diet.
  • Dapsone also has unwanted side effects. To avoid them, take low doses for a short period of time. Some of the common side effects of dapsone include: (6)
    • Headaches
    • Kidney damage
    • Peripheral neuropathy
    • Fatigue
    • Anemia
    • Leukopenia (decreased number of white blood cells)
• Topical creams
  • Topical creams often contain the steroid cortisone. Cortisone helps to suppress your immune system’s reaction which decreases symptoms. Unfortunately, cortisone creams also have unwanted side effects including:
    • Thinning of the skin
    • Rashes

These medications only help alleviate the symptoms. They are not a cure for DH.

Looking for more information? Check out our other blog posts about gluten.

Now, I want to hear from you!

Has a gluten-free diet improved your skin?