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Doctors on Celiac Disease Skin Rashes


									                     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:

  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

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.

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