Understanding Dermatitis Herpetiformis and Your Diet
Dermatitis herpetiformis (DH) is a chronic autoimmune skin disease that results from a gluten sensitivity. When a susceptible person ingests gluten, the immune system produces an antibody (immunoglobulin A) that deposits in the skin, causing the intensely itchy and blistering rash. Most people with DH also have celiac disease, although they may not experience the associated digestive symptoms. Therefore, the most important step in controlling DH is adhering to a strict, lifelong, gluten-free diet (GFD). However, gluten isn't the only dietary consideration; some individuals may need to adjust other parts of their diet to find relief.
The Cornerstone of Treatment: A Strict Gluten-Free Diet
Adopting a GFD is not just about avoiding wheat bread. It involves meticulously checking every food and ingredient. The healing process is not instantaneous; it can take months or even years for the rash to completely subside on a GFD, but consistent adherence is key to long-term remission.
Gluten-Containing Grains to Eliminate
To manage DH, you must remove all sources of gluten. This requires avoiding the following grains and their derivatives:
- Wheat: This includes all varieties like spelt, durum, emmer, farina, farro, graham, and kamut. Avoid all products made with wheat flour, such as bread, pasta, cakes, cookies, and pastries.
- Barley: Found in many beverages, including beer and ale, as well as in barley malt syrup and certain food additives.
- Rye: Used in some breads, cereals, and baked goods.
- Triticale: A hybrid of wheat and rye.
The Case for Oats
While pure, uncontaminated oats are naturally gluten-free, they pose a significant risk for those with DH due to cross-contamination during harvesting and processing. For this reason, individuals with DH should only consume oats that are specifically certified as gluten-free. Some people may still react to even certified gluten-free oats, so it is best to introduce them slowly and monitor for any adverse effects.
Hidden Gluten in Processed Foods
Gluten can hide in surprising places, acting as a binder, thickening agent, or flavoring. Always read ingredient labels carefully for these hidden sources. Common culprits include:
- Sauces and Condiments: Soy sauce, marinades, salad dressings, and ketchup often contain wheat.
- Processed Meats: Deli meats, hot dogs, sausages, and meatballs can use gluten as a filler or binder.
- Snack Foods: Many flavored chips, pretzels, and granola bars contain gluten.
- Soups and Broths: Many commercial soups and bouillon cubes contain wheat as a thickening agent.
- Sweets: Some candies, chocolate bars, and malted products contain gluten.
Consideration for High-Iodine Foods
For some individuals with DH, high levels of dietary iodine can provoke flare-ups, even while on a strict GFD. This is not true for all patients, but it may be a factor if skin symptoms persist. You should consult with your dermatologist or doctor before significantly changing your iodine intake. Foods high in iodine to consider limiting include:
- Iodized Salt: Switch to non-iodized salt for cooking and seasoning.
- Seaweed Products: Kelp, nori (used in sushi), and other sea vegetables are extremely high in iodine.
- Fish and Shellfish: Particularly tuna, shrimp, and cod.
- Dairy Products: Milk, yogurt, and cheese contain varying amounts of iodine, which is often added to livestock feed.
Preventing Cross-Contamination: A Practical Guide
Cross-contamination occurs when gluten-free food comes into contact with gluten. This is a major concern for those with DH. Follow these guidelines to maintain a safe kitchen:
- Separate Surfaces and Utensils: Use separate cutting boards, toasters, pots, and pans for preparing gluten-free food. If this is not possible, clean all surfaces and equipment thoroughly with hot, soapy water.
- Dedicated Storage: Store gluten-free products in separate, clearly labeled containers above gluten-containing items to prevent crumbs from falling onto them.
- Wash Thoroughly: Always wash your hands, sponges, and dish towels after handling any foods containing gluten.
- Consider Restaurant Dining: When eating out, inform the staff about your condition and be aware of potential cross-contamination in shared fryers or cooking areas.
Comparison Table: Gluten vs. High-Iodine Triggers
| Feature | Gluten (Wheat, Rye, Barley) | High Iodine Foods (Kelp, Shellfish, Iodized Salt) |
|---|---|---|
| Significance | Primary Trigger | Potential Secondary Trigger |
| Immune Response | Autoimmune Reaction | Exacerbates Pre-existing Condition |
| Required Action | Lifelong Strict Avoidance | Case-by-Case Basis with Medical Advice |
| Symptom Effect | Causes Rash & Blisters | Can Worsen Rash if Persistent |
Your New Shopping and Cooking Habits
Mastering your diet with DH requires becoming an expert label reader. Always look for "Certified Gluten-Free" labels on packaged foods. Focus on naturally gluten-free whole foods such as fresh fruits, vegetables, meat, fish, eggs, and plain dairy products. For cooking, experiment with gluten-free flours like rice, millet, or quinoa.
The Importance of Lifelong Adherence
While the initial dietary changes can be challenging, maintaining a strict GFD offers significant long-term benefits beyond just clearing up the skin rash. Adherence can reduce the need for medications like dapsone and decrease the risk of related health issues, such as osteoporosis and certain types of lymphoma, which are associated with celiac disease.
Conclusion
Managing dermatitis herpetiformis is a multifaceted process centered on dietary control. The primary and most critical step is the complete elimination of gluten. For some, monitoring and potentially reducing high-iodine food intake may also be necessary. By combining a meticulous gluten-free diet with careful attention to potential cross-contamination, many people can successfully manage their symptoms and significantly improve their quality of life. Always work closely with a healthcare provider and a dietitian to ensure your dietary plan is both safe and nutritionally sound.
Visit the Celiac Disease Foundation for more information on living gluten-free.
