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Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is a chronic disease of the skin that may occur in people of any age, but is most common in the second to fourth decades of life.1

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Vitamin E


Betaine HCl
Folic acid (if deficient)
Iron (if deficient)
Multiple vitamin-mineral
Vitamin B12 (if deficient)
Vitamin B3 (nicotinamide, when combined with tetracycline)
Zinc (if deficient)

a Reliable and relatively consistent scientific data showing a substantial health benefit
d Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and or minimal health benefit.

What are the symptoms of dermatitis herpetiformis?
DH is characterized by intensely itchy hives or blister-like patches of skin located primarily on elbows, knees, and buttocks, although other sites may be involved. A burning or stinging sensation may accompany the itching.

Dietary changes that may be helpful for dermatitis herpetiformis
The cause of DH is mainly an allergic reaction (called hypersensitivity) to foods (wheat and other grains) containing a protein called gluten. People with DH are usually found to have abnormalities of the intestinal lining identical to that of celiac disease (also called gluten-sensitive enteropathy or celiac sprue),2 a serious intestinal disorder also due to gluten sensitivity. Unlike celiac disease however, gastrointestinal symptoms may be mild or absent in DH.3 4 5 6

Strict adherence to a lifelong gluten-free diet (GFD) can eliminate symptoms of DH and the intestinal abnormalities, as well as reduce or eliminate the need for medication in most people. However, an average of 8 to 12 months of dietary restriction may be necessary before symptoms resolve.7 8 9 10 11 12 13 14 15

An increased incidence of lymphoma (cancer of the lymph tissue),16 17 18 and certain autoimmune and connective tissue disorders19 20 have also been reported in DH. Preliminary studies suggest a strict GFD of at least five years’ duration may reduce the increased risk of developing lymphoma in DH.21 22 23

Not all people with DH improve on a GFD and/or medication. Preliminary studies indicate sensitivity to other dietary proteins may be involved.24 25 26 Some practitioners would recommend an elimination diet and/or allergy testing to check for other food sensitivities.

A milk-free diet may improve symptoms of dermatitis herpetiformis, according to uncontrolled preliminary reports. In these reports, intake of milk products intensified symptoms of DH in two patients despite adherence to a gluten-free diet. The combination of a milk-free and gluten-free diet was effective, however.27 28

Nutritional supplements that may be helpful for dermatitis herpetiformis
People with DH frequently have mild malabsorption (difficulty absorbing certain nutrients) associated with low stomach acid (hypochlorhydria) and inflammation of the stomach lining (atrophic gastritis).29 Mild malabsorption may result in anemia30 and nutritional deficiencies of iron, folic acid,31 32 vitamin B12,33 34 and zinc.35 36 37 More severe malabsorption may result in loss of bone mass.38 Additional subtle deficiencies of vitamins and minerals are possible, but have not been investigated. Therefore, some doctors recommend people with DH have their nutritional status checked regularly with laboratory studies. These doctors may also recommend multivitamin-mineral supplements and, to correct the low stomach acid, supplemental betaine HCl (a source of hydrochloric acid).

Para-aminobenzoic acid (PABA) in high amounts (9–24 grams per day) has been reported to reduce or eliminate the skin lesions of DH in one preliminary, clinical trial.39 With continued administration, people with DH remained symptom-free for as long as 30 months. Since supplementation with such large amounts of PABA has the potential to cause side effects, these amounts should be used only with medical supervision.

A deficiency in the selenium-containing antioxidant enzyme known as glutathione peroxidase has been reported in DH.40 41 Preliminary42 and double-blind43 trials suggest that supplementation with 10 IU of vitamin E and 200 mcg of selenium per day for six to eight weeks corrected this deficiency but did not lead to symptom improvement in the double-blind trial.

There is preliminary evidence that, when drug therapy with dapsone is not tolerated, people with DH may respond to a combination of the antibiotic, tetracycline, and nicotinamide (a form of vitamin B3).44 45 However, this course of treatment should only be tried under the supervision of a physician.

Are there any side effects or interactions with dermatitis herpetiformis?

Refer to the individual supplement for information about any side effects or interactions.