What is a gluten rash?
The rash that most people call a “gluten allergy rash” or “gluten rash” is an autoimmune disorder, most closely associated with celiac disease. Gluten rash also is known as “dermatitis herpetiformis.” It generally does not occur in conjunction with gluten intolerance or sensitivity, though a wheat allergy can cause a hive-like skin rash that is very different from dermatitis herpetiformis.
Gluten rash is caused by an abnormal immune system response to consuming gluten, a protein found in wheat. A small percentage of people with celiac disease also develop a gluten rash, and it’s possible to have the skin rash without having the digestive symptoms of celiac disease (such as bloating and diarrhea). A gluten rash is caused by consuming gluten, not from touching or handling a food containing gluten.
Gluten rash typically develops near middle age and is caused by eating wheat products like bread and crackers. Gluten also can be present in many processed and packaged foods, such as sauce mixes and beer. People who have a gluten rash must strictly avoid eating gluten. Read food labels to discover if a product contains gluten. Many foods today have labels that indicate whether a food is gluten-free or not.
Current evidence suggests a person cannot develop dermatitis herpetiformis from gluten intolerance or sensitivity alone. The gluten rash occurs almost exclusively with celiac disease, which is sometimes called “gluten allergy,” though celiac disease is actually an autoimmune disorder.
Gluten rashes are blistery, pitted, or pustular and very itchy. A gluten rash on the elbows is common, and it also can appear on the knees, buttocks, back, or face, at the hairline. The rash is symmetrical, which means it occurs on both sides of the body at the same time. Teeth may also show erosion as a feature of gluten rash. While a gluten rash generally isn’t life threatening the way food allergy rashes may be, you should consult your primary care provider if you develop an itchy, pustular rash on your knees or elbows. Your doctor may evaluate you for celiac disease.
Unlike food allergy rashes that flare up severely in response to consuming a food and then immediately go away when the food is avoided, a gluten rash is chronic (long-lasting) and may not clear up simply by avoiding gluten. The main medical treatment for a gluten rash is a drug called sulfone dapsone, which often has a dramatic, positive effect on the rash. Home treatment includes avoiding gluten, along with comfort care, such as applying cool compresses to the affected skin.
What other symptoms might occur with gluten rash?
Because a gluten rash can be a symptom of celiac disease, you might experience digestive symptoms along with the rash. These symptoms might include:
- Bloating and gas, especially after eating wheat products
- Chronic diarrhea
- Stomach pain or cramping
- Stools that float and appear pale or fatty
Some experts estimate that fewer than 20% of people with a gluten rash also exhibit digestive symptoms. See a medical professional to evaluate any itchy, blistering skin rashes.
What causes a gluten rash?
A gluten rash occurs when immunoglobulin A (a type of antibody) deposits itself in the skin in response to a gluten allergy. This inappropriate immune system response causes inflammation, blistering and itching of the areas where the deposits occur. The primary way doctors diagnose gluten rash is by taking a small biopsy sample of the affected skin to see if it is filled with immunoglobulin A proteins.
What are the risk factors for gluten rash?
An autoimmune reaction to gluten causes dermatitis herpetiformis. About 10 to 15% of people with celiac disease develop gluten rash. Having an autoimmune disease increases your risk of other autoimmune diseases. People at risk for gluten rash include those with lupus, type 1 diabetes, thyroid disease, and Sjögren syndrome.
Reducing your risk of gluten rash
Consuming wheat- and other gluten-containing foods and drinks trigger the autoimmune reaction, so people diagnosed with celiac disease must abstain from gluten entirely.
What are treatments for gluten rash?
The main treatment for gluten rash is the medication dapsone and avoiding gluten. Dapsone has a dramatic effect, relieving itching and preventing new lesions. However, it can take several months or longer for the rash to fully subside. Following a lifelong, gluten-free diet will prevent additional bouts of gluten rash. There is evidence iodine can make gluten rash symptoms worse. Talk with your doctor about the possibility of cutting iodine from your diet, as iodine is necessary for normal thyroid gland function.
Home remedies for gluten rash (and other itchy rashes) include:
- Cool compresses, to relieve itching and pain
- Pure aloe vera gel, to calm the itchiness
- Warm, not hot showers and baths, to prevent further skin irritation
- Acetaminophen, to relieve pain
- Moisturizers with a “barrier” ingredient, like dimethicone, to protect the skin
There is some evidence that nonsteroidal anti-inflammatory drugs can make gluten rash worse, so do not take ibuprofen or naproxen for pain relief unless directed by a doctor with experience treating gluten rash.
What are the potential complications of gluten rash?
When a gluten rash heals, it can leave behind scars or discolored skin. The celiac disease that may underlie a gluten rash can cause serious complications left untreated, including:
- Intestinal cancers
- Multiple sclerosis and other types of autoimmune disorders
- Neurological conditions like migraine
Adults and children who develop a gluten rash on the elbows, knees, back, buttocks, or hairline should be evaluated promptly by a medical professional for diagnosis. The best treatment for a gluten rash is strict adherence to a gluten-free diet, with follow-up care as directed by your healthcare provider.