Celiac disease is an autoimmune disease wherein gluten — a protein found in wheat, rye, triticale, and barley — triggers an immune system response in the small intestine. Over time, this leads to damage of the intestine and many associated health complications. Symptoms can include abdominal pain, bloating, gas, diarrhea, constipation, vomiting, and other gastrointestinal issues, as well as fatigue.
There are also certain skin conditions that often occur in conjunction with celiac. While all but one of these conditions can be present in people without celiac, gluten may play a role in them when they accompany the disease. In fact, the connection to gluten can be so strong for some that simply removing the problematic protein from their diet can sometimes clear up the skin issue as well.
Below, we’ll look at some of these conditions, their symptoms, and ways they can be treated and managed.
Celiac-Associated Skin Conditions
Dermatitis herpetiformis (DH)
Also called Duhring disease, this chronic skin condition is the most common dermatological concern for those with celiac disease, affecting 10-15% of celiac patients. Dermatitis herpetiformis is more than just an associated skin condition; it’s technically the dermatological expression of celiac. Patients who have dermatitis herpetiformis but no gastrointestinal symptoms are still considered to have celiac disease.
Dermatitis herpetiformis is characterized by very itchy bumps or blisters that appear on both sides of the body. It’s most often found on the forearms, near the elbows, on or near the knees and buttocks, as well as along the hairline.
The first step in managing this ailment is ensuring it’s accurately diagnosed. Because it can look like other skin conditions (herpes, for instance), it’s often misdiagnosed. Confirming dermatitis herpetiformis requires a biopsy by a skilled, knowledgeable professional who is familiar with the illness, and knows how to correctly perform the biopsy.
Dermatitis Herpetiformis Management
A strict gluten free diet is the baseline for managing dermatitis herpetiformis, just as it is for all celiac patients. Cutting out gluten keeps the condition under control for many, but isn’t always enough, and flare-ups may require more acute treatment. Sometimes prescription medications may be the best treatment. Talk to your doctor to learn what the best medical course of treatment could possibly be.
Eczema (aka Atopic Dermatitis)
This common skin condition is denoted by a rash with itchy, scaly patches that sometimes “sweat” clear liquid. It’s more often seen in children than adults, and affects tens of millions of Americans each year. Some doctors consider eczema to be an autoimmune disease, as well.
While eczema is fairly common among the general population, controlled studies have found it to be present 3 times more often in people with celiac, and twice as frequently in relatives of those with celiac. Researchers think this might indicate a genetic link between the two conditions.
Aside from maintaining a gluten free diet (already a must for celiac sufferers), there are a number of ways to manage and treat eczema when it flares up, and help prevent future flare-ups. One of the main lifestyle changes you can make is avoiding contact with irritants that trigger it. Start by removing every suspected irritant and then slowly reintroducing each one at time to see which sets off the eczema. If you’re currently battling an eczema outbreak, you could start removing suspected triggers one-by-one until the rash gets under control.
A skincare regimen that includes warm baths and routine moisturizing can also be helpful. Over-the-counter cortisone creams or ointments can help with itching and, if needed, a prescription-strength topical corticosteroid can also be used.
Another fairly common skin condition, psoriasis is also an example of the immune system not behaving as expected in a person’s body. It’s been found to co-occur with over a dozen other autoimmune diseases, including celiac and rheumatoid arthritis. In one recent study one-third of psoriasis sufferers had higher levels of antibodies (proteins formed when the body tries to fight off a foreign substance) against gliadin — the component of gluten that people with celiac can’t digest.
In psoriasis patients, the skin cell life cycle speeds up and causes those cells to build up quickly on the surface of the skin. The extra skin clusters form thick, scaly, red, sometimes painful, patches. Some people with the disease also experience dry, cracked skin that may bleed, itching, burning, soreness, thickened or ridged nails, along with swollen and stiff joints.
Psoriasis is a chronic condition that can flare for weeks or months at a time, with periods of dormancy in between. There are treatment options, but no cure. Avoiding stress, not smoking, and moisturizing can help. Hydrocortisone creams and lotions, as well as prescription topical steroids can treat symptoms.
Chronic Urticaria (aka Hives)
Urticaria are sudden swollen, pale red bumps or “plaques” on the skin that can itch, burn or sting. Many people experience hives at one time or another, usually as a result of an insect sting, skin contact with an allergen, or ingestion of an allergen, though sometimes a direct cause is hard to pinpoint.
Individual hives do not usually last more than a full day, but the reaction that produces them could go on for weeks or months, with new patches popping up. Urticaria are considered chronic if they last more than 6 weeks.
Chronic Urticaria Management
If a gluten free diet is not enough to get rid of your chronic hives, there may be another trigger that needs to be removed. To figure out what it might be, pay attention to what you were doing, eating, drinking, or touching shortly before the hives appeared. If you’re already fighting a bout of hives that isn’t going away, try removing suspected culprits one-by-one every few days.
Cool compresses, loose fitting clothes, and sleeping in a cool environment can provide relief from hives. Calamine lotion can also help calm the skin, and relieve mild itching. Antihistamines such as Benadryl can tamp down the chemicals in the body that are associated with allergic reactions. Topical or oral corticosteroids can also be prescribed if the situation doesn’t respond to over-the-counter or home remedies.
In this autoimmune disease, the immune system attacks the hair follicles. This results in hair loss, usually starting in small patches. Hair may grow back on its own, then fall out again in the same spots or different spots. In severe cases, the disease can progress and lead to total body hair loss. A medical diagnosis is necessary to confirm the hair loss is not caused by another disease.
There are many potential components and causes of alopecia areata, but it seems to be more prevalent in people with family histories of other autoimmune diseases. Several studies have found links between it and celiac.
Alopecia Areata Management
In some who are diagnosed with both celiac and alopecia areata, cutting out gluten has resulted in hair regrowth. However, often treatment of this disorder is focused on hindering further loss by blocking the immune system from attacking the follicles. A dermatologist may recommend light therapy, as well as topical and oral medications, or prescribe steroids in injectable, oral, or topical form depending on the severity and spread of the urticaria.
While most people occasionally experience dry skin due environmental reasons like cold or dry air, it can be a chronic and severe problem for many. Extreme dry skin is rough to the touch, sometimes itchy and flaky, and may crack. Although there haven’t been many studies exploring the connection between celiac and dry skin, anecdotal evidence suggests that a high number of celiac patients struggle with chronic or recurring dry skin.
Dry Skin Management
Moisturizers can help mitigate the external aspects of dry skin, but heading off the underlying causes is the best way to affect systemic and lasting change. Treating and managing dry skin can best be accomplished via lifestyle changes such as staying hydrated and including more omega-3 rich foods — oily fish, walnuts, flax, chia seeds — in a balanced diet. Not smoking and avoiding other behaviors or environments that dry out skin can also help.
One quarter of people with an autoimmune disease are eventually diagnosed with a second and sometimes third such illness, so it’s not surprising that many autoimmune skin conditions coincide with celiac disease. Research on the negative reactions gluten can trigger in the body is always evolving and expanding, so it’s important to talk to your doctor if you have (or suspect you have) celiac and are experiencing any of the skin problems mentioned above. While most of these conditions can’t be cured, lifestyle changes and medications may go a long way in mitigating them and improving quality of life.
Disclaimer: No information on this site should be relied upon to determine diet, make a medical diagnosis, or determine treatment for a medical condition. The information on this website is not intended to replace your relationship with a qualified healthcare professional and is not intended as medical advice.