If you're suffering from an intensely itchy, red skin rash -- especially one that doesn't seem to respond to treatment -- you may want to look to your diet for a potential explanation. It's possible that your skin rash could be a condition called dermatitis herpetiformis, which is caused by gluten in your diet. Gluten occurs naturally in the grains wheat, barley and rye, and most Americans consume large quantities of gluten several times each day when they eat cereal, bread or pasta.
Basics
Dermatitis herpetiformis normally occurs in conjunction with celiac disease, an inherited condition that affects up to 1 percent of Americans, according to the Celiac Disease Center at Columbia University. When you have celiac disease, you suffer damage to the wall of your small intestine when you eat wheat, barley or rye. In dermatitis herpetiformis, your skin erupts when you consume those grains. Almost everyone with dermatitis herpetiformis has the intestinal damage that characterizes celiac disease, but not everyone with celiac disease will also have a skin rash.
Symptoms
Dermatitis herpetiformis sufferers often describe their rash as almost unbearably itchy. The itching usually starts before the pimple-like lesions erupt. The red lesions -- which often have a clear liquid center -- usually form in clusters, and usually appear in the same place on your body every time. Healing lesions leave purple spots. If you constantly consume gluten, you may have the rash constantly, but it sometimes wanes and then returns. Common locations for dermatitis herpetiformis include the elbows, knees, buttocks and chest.
Diagnosis
If you have an incredibly itchy rash that you suspect may be dermatitis herpetiformis, you should visit a dermatologist for a diagnosis. Your doctor most likely will perform a skin biopsy, which involves taking a small sample of your skin right next to an active lesion. The dermatologist then will examine the sample under a microscope to see if it shows the telltale signs of dermatitis herpetiformis. If it does, you may also be referred to a gastroenterologist, who will determine if you have intestinal damage from gluten ingestion.
Treatment
Your dermatologist may offer you some short-term relief from your symptoms in the form of a prescription medication called diamino-diphenyl sulfone, which can quickly curb the itching. However, this drug can lead to anemia if taken long-term. Therefore, treating your dermatitis herpetiformis long-term will involve following the gluten-free diet, which means giving up gluten-containing items and substituting gluten-free breads, pastas and other products. Fortunately, food manufacturers now offer an increasing array of gluten-free foods and many restaurants provide gluten-free menus for their customers, so following the gluten-free diet shouldn't be too difficult.
