What happens in the body
In celiac disease, the body produces antibodies to the enzyme tissue transglutaminase, which is involved in the processing of gluten. A related enzyme is also present in the skin, so antibodies are deposited at the tops of the dermal papillae, attract neutrophils there and trigger inflammation. This is how a rash occurs that has nothing to do with direct skin contact with food. At the same time, the villi in the small intestine are smoothed out, which makes iron, folic acid and other substances less absorbed. In this case, intestinal complaints may be completely absent, and the skin is the only noticeable manifestation of the disease.
- Antibodies are deposited in the skin papillae
- Inflammation occurs regardless of skin contact with food
- Villi are smoothed out in the small intestine
- Intestinal complaints are often absent
- Often combined with anemia and deficiencies
- Associated with other autoimmune diseases
Symptoms
The main complaint is excruciating itching and burning, which often precedes the rash itself by several hours. The rashes are small dense blisters and nodules on red, swollen spots, grouped, which is why the disease is called herpetiformis, although it has nothing to do with herpes. Due to scratching, the blisters are rarely visible entirely: crusts, excoriations and traces of old rashes are more often visible. The location is strictly symmetrical: the extensor surfaces of the elbows and knees, buttocks, shoulders, lower back, scalp. The current is undulating, for years.
- Severe itching and burning until a rash appears
- Grouped small bubbles and nodules
- Symmetrical placement on elbows, knees, buttocks
- Scratching, scabs, dark spots at the site of rashes
- Wave-like current
- Intestinal complaints are often absent
Diagnostics
A skin biopsy is of decisive importance, and the material is taken not from the vesicle itself, but from apparently healthy skin next to the rash: direct immunofluorescence reveals characteristic deposits of immunoglobulin A in the dermal papillae. Antibodies to tissue transglutaminase and endomysium are determined in the blood, which confirm celiac disease. An important condition: before these studies you cannot switch to a gluten-free diet, otherwise the result will be false negative. The gastroenterologist evaluates the need for endoscopy with biopsy of the small intestine. Additionally, iron, vitamins and thyroid function are checked.
- Biopsy of healthy skin near the rash
- Direct immunofluorescence to detect IgA deposits
- Antibodies to tissue transglutaminase in the blood
- Endoscopy with biopsy of the small intestine according to the decision of the gastroenterologist
- Screening before starting a gluten-free diet
- Complete blood count, iron, vitamins, thyroid hormones
Gluten-free diet is the basis of treatment
The only way to influence the cause of the disease is to completely eliminate gluten: wheat, rye, barley and everything made from them. The diet must be strict and lifelong, since even small amounts of gluten support inflammation. The effect on the skin does not occur immediately: itching and rashes decrease over the course of months, and complete cleansing may take a year or more. But the diet also heals the intestines, eliminating deficiencies and reducing long-term risks. You have to carefully read the ingredients of products all the time: gluten is found in sauces, sausages, semi-finished products, and some medicines.
- Complete exclusion of wheat, rye and barley
- Strict and lifelong adherence to the diet
- Carefully reading the composition of finished products and sauces
- Separate dishes and boards to avoid crumbs
- Rice, buckwheat, corn, meat, fish, vegetables and fruits are allowed
- Discussing oats with a doctor - they are not for everyone
Drug treatment and observation
Since the diet acts slowly, in the first months the doctor may prescribe a drug that quickly suppresses itching and rashes. It does not replace diet and requires monitoring of blood tests due to possible side effects, so it should only be taken under supervision. As the diet takes effect, the dose is reduced and then the drug is discontinued. External remedies and antihistamines help little with this rash. In the future, periodic visits to a gastroenterologist are needed, monitoring antibodies, iron and vitamin levels, as well as checking the thyroid gland, since concomitant autoimmune diseases are common.
- Drug for rapid control of itching as prescribed by a doctor
- Mandatory monitoring of blood tests during treatment
- Gradual withdrawal of the drug as the diet takes effect
- Monitoring of antibodies and intestinal condition by a gastroenterologist
- Correction of deficiency of iron, folic acid, vitamins
- Checking your thyroid gland and sugar levels