It can be difficult to make the connection to celiac disease (CD), or gluten intolerance, when rashes, bumps or lesions appear on the skin. Celiacs seem prone to various forms of dermatitis; itchy skin might be stress-related or due to immunological responses, nutritional deficiencies, allergies or dryness. CD is characterized by an abnormal immune response to gluten, a protein in wheat, barley and rye. The destruction of villi in the small intestine is the main target of this immune response, but some skin conditions are also associated with CD.
Dermatitis Herpetiformis
As the name implies, dermatitis herpetiformis (DH) looks herpetic and is sometimes mistaken for a herpes virus. Red plaques erupt in groups of blisters, and the resulting intense itch can disturb sleep. Most often, DH afflicts people between the ages of 15 and 40. The rash usually appears bilaterally on the outer surfaces of the elbows, forearms, buttocks and knees, although other sites may include the face, scalp and torso. These lesions often form scars. People with DH have a condition of the intestinal tract identical to that found in celiac disease, although gastric symptoms might be absent.
Medication, in conjunction with gluten dietary restriction, can be used to suppress eruptions. A strict gluten-free diet may take weeks to clear up an outbreak. Accidental ingestion of gluten will cause symptoms to re-occur.
Psoriasis
A review of cutaneous (skin) manifestations in celiac disease published in the "World Journal of Gastroenterology" pointed to a high frequency of gluten intolerance in psoriatic patients. An inflammatory autoimmune disease, psoriasis is characterized by raised red patches of thick scaly skin that may burn, itch, crack and bleed. Flareups may be worse in the winter. A gluten-free diet may lessen symptoms. The researchers suggested three ways in which the skin disorder might be associated with celiac disease: abnormal permeability of the small intestine exists in both conditions; a sensitization of immune cells (T-cells) in the blood occurs in CD, and there is an increased number of T-cells in the blood and skin of psoriasis sufferers; and vitamin D deficiency is common in celiac disease, and may play a role in the development of psoriasis lesions.
Hives
A case-controlled study involving children with chronic uticaria, defined as hives that lasted at least six weeks and did not respond to antihistamines, found that 5 percent of subjects tested positive for celiac disease. This was significantly higher than in control groups. The hives disappeared when these children were fed a gluten-free diet. Researchers concluded that treatment of chronic uticaria should include testing for gluten intolerance.
