VIEWS: 249 PAGES: 3 POSTED ON: 3/5/2010
Doctors on Celiac Disease & Skin Rashes Taken from Clan Thompson website The definitive test for dermatitis herpetiformis is a biopsy. Skin immediately adjacent to a lesion should be taken for direct immunoflourescence. It is important that a laboratory with particular expertise in dermatopathology process these biopsies. We would be more than happy to process your biopsy and help your physician in interpreting the results. You and your physician can access information about this at our website: http://uuhsc.utah.edu/derm/immunoderm/. QUESTION: My husband was diagnosed with CD nearly 2 years ago and he has been GF ever since with the exception of a couple of accidental ingestions. He is feeling much better except for one thing that may or may not be celiac related. He has been plagued with itching over most of his body, sometimes accompanied with a terrible rash. He has seen numerous doctors over the years -- allergists, dermatologists, gastroenterologist for the GI symptoms, family practitioners for general medicine -- and no one has been able to pinpoint the problem or cure the itching. One doctor told him he thought he was allergic to his own perspiration. He has had a rash ever since he was a little boy(at that time they just called it prickly heat or heat rash), but the GI symptoms did not develop until he was around 42. It took about 15+ years to be correctly diagnosed wth CD. The longer he is on the GF diet, the rash seems to be getting better, however, the itching persists, most of the time not as bad as before going GF. Along the way, he was tested for numerous allergies and takes allergy injections for ragweed and grasses, etc. He did test slightly positive for some food allergies but we were told they were so slight that it was not necessary to avoid them. Last week, we saw yet another dermatologist for the rash on his scalp, neck, back, chest, and arms. We thought that possibly he had DH even though the rash does not look like the pictures we have seen. The fact that it seems to be getting better the longer he is GF seemed to give a clue. He also reacted to a shampoo that contained wheat germ. DH seemed to make sense to us. We, therefore, eliminated all topical products that contain gluten. The dermatologist said that from what she could see, it was not a classic case of DH, but it could still be DH. She said there was no lesion to biopsy, so a biopsy would be worthless. There would be no point to doing a biopsy on his rash. The rash looks like raised red bumps that sometimes resemble a pimple. She says she thinks there are several things going on from eczema on his arms to seborrhea on his scalp and gave him 5 different prescriptions -- shampoo and another solution for his scalp, an ointment for his arms, a lotion for his back and pills for the intense itching. She also recommended that we use free and clear laundry soaps, bath soaps, deodorants, etc. We have made the suggested changes -- most of which we were already doing. We are so frustrated at this point. He continues to itch -- even on his legs and feet where there is no rash at all. The pill that she gave him for itching puts him to sleep immediately, so I guess we should be grateful for that because we can both get some sleep anyway. My question is whether itching and rashes are a common occurrence with CD patients. Do you have patients with these problems and what do you recommend? Are we on the right track with a dermatologist or should we be seeing an allergist or another type of doctor? I know it is difficult for you to give an opinion without really seeing the rash, but we would really appreciate your input. DR. RUDERT: Rashes, indeed, are a common occurrence in patients with Celiac Disease. The majority of the time the rash is not DH; however, individuals must remember in order to correctly diagnose DH, a skin biopsy must be obtained from the normal skin adjacent to the lesion. Generally, DH takes longer to resolve than the small bowel abnormalities on a gluten-free diet. DH may take six months or longer. I would recommend that all topical products such as shampoos, lotions and creams be gluten-free (although others may not agree with me). I recently had an individual with a long- standing severely itchy rash that we determined was on the basis of an underlying infection called H. Pylori. This is a bacteria that invades the lining of the stomach and if present can be treated with appropriate antibiotic therapy. After treatment, her rash of over 15 years spontaneously resolved. Co-incidentally, she also had an occult (hidden) dental abscess. A repeat endoscopy could re-evaluate his Celiac status (with small bowel biopsies) and gastric biopsies could also be obtained looking for H. Pylori. Blood testing could be obtained as an initial screen; however, it is not as sensitive as endoscopy. I would also recommend repeat Celiac antibodies. I hope this helps. QUESTION: I read that celiacs were prone to skin rashes. Why is that? Is there any testing that can be done to figure out what the problem is? I have had a non-itchy rash on my forearms for over a year. I am a biopsy-diagnosed celiac but never had DH. The rash is not bothersome but it makes me wonder if something else internal is wrong. Is there anything that can be done to get rid of it? DR. ZONE: Patients with celiac disease may get common skin disorders just as patients without celiac disease. Things such as acne, eczema and psoriasis are common in the general population, as well as in patients with celiac disease. However, these disorders are no more common than in patients without celiac disease. There is a very specific disease that is associated with celiac disease called dermatitis herpetiformis. It ususally presents as itchy bumps on the forearms, elbows, and knees. Definitive diagnosis of dermatitis herpetiformis can always be made by biopsy and if a celiac patient suspects that they have dermatititis herpetiformis, they should see a dermatologist and request a biopsy for immunofluorescence in order to confirm this diagnosis. If a specific patitent or doctor would like to have this test done, we do provide processing of these biopsies as a clinical service. Insurance companies usually cover this. In your situation, the most important thing would be to get a definite diagnosis as to the nature of your rash. I would suggest that you see a dermatologist who can give you a definitive diagnosis and then answer for you whether or not it is associated with any internal problem and the best way to treat it.
"Doctors on Celiac Disease Skin Rashes"