Dermatitis Herpetiformis (Holistic)

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About This Condition

This rare but serious food allergy can cause uncomfortable rashes. According to research or other evidence, the following self-care steps may be helpful.
  • Get extra antioxidants

    Take a daily supplement containing 10 IU of vitamin E and 200 mcg of selenium to prevent a common deficiency linked to DH

  • Give up gluten

    To avoid the allergic reaction that causes DH, eat a diet free of wheat, rye, and barley

About

About This Condition

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

Symptoms

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.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Forego milk
A milk-free diet may improve symptoms of dermatitis herpetiformis, according to preliminary reports.

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.

Give up gluten
To avoid the allergic reaction that causes dermatitis herpetiformis, eat a diet free of wheat, rye, and barley.

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), a serious intestinal disorder also due to gluten sensitivity. Unlike celiac disease however, gastrointestinal symptoms may be mild or absent in DH.

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.

An increased incidence of lymphoma (cancer of the lymph tissue), and certain autoimmune and connective tissue disorders 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.

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

Supplements

What Are Star Ratings?
Supplement Why
2 Stars
Selenium
200 mcg daily
Supplementing with selenium and vitamin E has been shown to correct an antioxidant deficiency common in DH.

A deficiency in the selenium-containing antioxidant enzyme known as glutathione peroxidase has been reported in DH. Preliminary and double-blind 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.

2 Stars
Vitamin E
10 IU daily
Supplementing with selenium and vitamin E has been shown to correct an antioxidant deficiency common in DH.

A deficiency in the selenium-containing antioxidant enzyme known as glutathione peroxidase has been reported in DH. Preliminary and double-blind 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.

1 Star
Betaine Hydrochloride
Refer to label instructions
To correct the low stomach acid that often occurs with DH, some doctors recommend betaine HCI, a source of hydrochloric acid.

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). Mild malabsorption may result in anemia and nutritional deficiencies of iron, folic acid,vitamin B12, and zinc. More severe malabsorption may result in loss of bone mass. 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).

1 Star
Folic Acid
Refer to label instructions
Supplementing with folic acid can counteract the nutrient deficiency that often occurs as a result of malabsorption.

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). Mild malabsorption may result in anemia and nutritional deficiencies of iron, folic acid,vitamin B12, and zinc. More severe malabsorption may result in loss of bone mass. 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).

1 Star
Iron (Iron-Deficiency Anemia)
Refer to label instructions
Talk to your doctor to see if supplementing with iron can counteract the nutrient deficiency that often occurs as a result of malabsorption.

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). Mild malabsorption may result in anemia and nutritional deficiencies of iron, folic acid,vitamin B12, and zinc. More severe malabsorption may result in loss of bone mass. 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).

1 Star
Multivitamin
Refer to label instructions
Because of the malabsorption that often occurs with DH, some doctors recommend a multivitamin-mineral supplement.

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). Mild malabsorption may result in anemia and nutritional deficiencies of iron, folic acid,vitamin B12, and zinc. More severe malabsorption may result in loss of bone mass. 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).

1 Star
PABA
Refer to label instructions
PABA in high amounts has been reported to reduce or eliminate the skin lesions of DH in one preliminary trial.

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. 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.

1 Star
Vitamin B12 (Vitamin B12 Deficiency)
Refer to label instructions
Supplementing with vitamin B12 can counteract the nutrient deficiency that often occurs as a result of malabsorption.

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). Mild malabsorption may result in anemia and nutritional deficiencies of iron, folic acid,vitamin B12, and zinc. More severe malabsorption may result in loss of bone mass. 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).

1 Star
Vitamin B3 with Tetracycline
Refer to label instructions
 
1 Star
Zinc
Refer to label instructions
Supplementing with zinc can counteract the nutrient deficiency that often occurs as a result of malabsorption.

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). Mild malabsorption may result in anemia and nutritional deficiencies of iron, folic acid,vitamin B12, and zinc. More severe malabsorption may result in loss of bone mass. 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).

References

1. Gawkrodger DJ, Blackwell JN, Gilmour HM, et al. Dermatitis herpetiformis: diagnosis, diet and demography. Gut 1984;25:151-7.