How long after consuming gluten does dermatitis herpetiformis appear?

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Okay… so after a gluten sensitive person consumes gluten, does dermatitis herpetiformis appear on the skin, an hour later, a day, a week… how long? There isn’t a definitive answer. It depends on how sensitive you are. Also not all gluten sensitive people develop DH. Here is a quote from Dr Green’s book, Celiac Disease- A Hidden Epidemic. “There is a definite spectrum of sensitivity to gluten in those with DH, and some people are exquisitely sensitve to even trace amounts. The occurrence of lesions after an ingestion of gluten (anywhere for several hours to several days) is another indication of this condition.”

Dermatitis herpetiformis (DH) is an intensely itchy skin eruption. It usually shows up inyoungadults, and is more common in men and people originally from some areas of northern Europe. The symptoms are intense burning, stinging and itching around the elbows, knees, scalp, buttocks and back. More locations can also be affected and the severity can vary.

DH looks like small clusters of red, itchy bumps. There are tiny water blisters, but these are quickly scratched off. Before they form, the area usually has a burning feeling. They scab and heal over one or two weeks, but new spots continue to appear. DH is a lifelong condition, but remission may occur in 10 to 20 percent of patients. The rash is caused when gluten in the diet combines with IgA, and together they enter the blood stream and circulate.

They eventually clog up the small blood vessels in the skin. This attracts white blood cells (neutrophils), and releases powerful chemicals called complements. They actually create the rash. Iodine is required for the reaction, so people with DH should avoid using Iodized salt.

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Diagnosis of DH usually requires at least one skin biopsy, and sometimes a blood test (looking for anti-gliadin, anti-reticulin and anti-endomysial antibodies). Once confirmed, treatment will be lifelong, although severity may wax and wane. Complete elimination of gluten is curative, but improvement takes months. The gluten-free diet is very difficult, as tiny amounts of gluten are in almost all restaurant and prepared foods, gum wrappers.

Cutting down on wheat and gluten are may reduce the amount of medication needed. Dapsone is a drug that will improve DH in days. Because there can be side effects, the dose of Dapsone is usually started at a small amount, and then raised up over a few weeks until all symptoms are suppressed. Dapsone may have adverse effects, so weekly or bi-weekly blood tests will be needed for the first three months

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