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Celiac disease and your skin

May 17, 2020 / Duncan Fisher
Some patients show signs – here’s what they are

Celiac disease is an intestinal disorder, a fairly common one, that arises in reaction to gluten.

‘Gluten’ is a collective term for a large group of storage proteins that grow naturally in a number of grains, notably wheat. Gluten is not a bad thing by itself. It’s what holds bread together, and makes pizza dough stretchy. There’s evidence that it’s actually good for us, a prebiotic booster of the beneficial bacteria that grow in our gut.

But some people get sick when they eat gluten. Symptoms of this celiac disorder can vary quite a lot, and be mistaken as evidence of irritable bowel syndrome, Crohn's Disease, or gastric ulcers. But it’s not these things. Nor is it an allergy or an intolerance, though it can look like both.

Celiac disease is an auto-immune disorder. Tendency to develop it may in part be hereditary. There appear to be statistical comorbidities with other diseases, like diabetes and osteoporosis.

There isn’t a cure, but strictly avoiding gluten, fortunately, will stop the symptoms, sometimes within days.

That means not eating things like pasta, bakery treats, or cereal, or anything in whose production gluten may have been involved, which can mean processed meat, soups and sauces, and even beer. It can be tricky to live gluten-free. It’s wise to consult a dietician about how to do it.

Why are we telling you this in a dermatology practice website?

Because there can be dermatological signs of celiac disease. They’re pretty common, too. About 1 in 5 celiac patients show some skin involvement. It happens more often in men than in women, and tends to appear first among teenagers. Outside the celiac population, the skin signs that celiac patients get are quite rare.

What does celiac skin involvement look like?

Symptoms can vary, but for most patients it’s an itchy, blistering rash spoken of as ‘dermatitis herpetiformis’.

It typically starts with burning sensations on the knees or elbows, or on the scalp, buttocks, or back. Clusters of itchy, red bumps form, that scab over. It looks very much like a herpes infection (hence its name).

What to do about it?

If you are a celiac patient, the important thing is to get off gluten, right away, and be quite strict about it.

The rash usually clears after that, as do the other symptoms. It can be slow to work, so your dermatologist might also offer medication, like oral dapsone, or a topical corticosteroid cream.

There are skin care products and cosmetics that contain gluten, and patients worry that these will cause problems.

They’re actually okay to use. The herpetiform dermatitis in celiac disease is caused by eating gluten, not putting it on your skin. These products shouldn’t be used around the mouth, though, and dental products that contain gluten – some toothpastes and mouthwashes do – shouldn’t be used at all.

If you think you’re getting a rash that is related to a skin care product, see your dermatologist. It may be that you have an allergy. In celiac patients, for some reason, skin products that contain iodine are known to make the dermatitis worse. That too would be worth an investigation with your doctor.

In sum, rashes don’t mean you have celiac disease. But if you have the disease, you may well have a rash with it. Treat the disease, and in general, you’ll treat that rash.