Celiac disease and skin problems are closely connected, but not every rash is dermatitis herpetiformis—and gluten touching intact skin does not activate celiac disease.
Celiac disease is a systemic autoimmune disease.
Today, we are talking about the skin.
Before we go much further, let’s clear up one common misconception: Gluten does not pass through intact skin and trigger celiac disease.
Imagine trying to fit a basketball (gluten) through a doughnut hole (a pore). Gluten proteins are simply too large. Note that this is just a way to describe the relationship—it is not a true size comparison. Gluten cannot cross the intact skin barrier in a way that activates celiac disease.
So, gluten-free lotions, shampoos, and makeup are not medically necessary for celiac disease unless there is a realistic chance you will swallow the product. And if you are swallowing shampoo or lotion, that’s a different problem. 😉
The main concern with gluten-containing lotions, makeup, or personal-care products is ingestion—not absorption through your skin. Lipstick, lip balm, toothpaste, mouthwash, and other products used directly in or around the mouth should be gluten-free.
And washing your hands with soap and water before putting food or your fingers into your mouth should be a no-brainer—gluten-free or not.
Now let’s talk about dermatitis herpetiformis—you know, the celiac rash.
Dermatitis herpetiformis, or DH, is the specific skin manifestation of celiac disease. It usually causes intensely itchy clusters of bumps or small fluid-filled blisters on reddened skin.
It is most often found on the elbows, knees, buttocks, scalp, and back.
It is often symmetrical. If it appears on one elbow, knee, or side of the buttocks, it will commonly appear on the other side too.
DH is diagnosed by a dermatologist using a biopsy of normal-looking skin beside the rash—not the blister itself.
Celiac blood tests may be positive, but they are not positive in every person with DH. The small intestine may show anything from mild changes to significant villous damage, even when the person has no digestive symptoms.
DH is caused by eating gluten, not by touching it.
Treatment usually includes a strict gluten-free diet. Dapsone may also be prescribed because it can control the itching and rash quickly while the gluten-free diet gradually treats the underlying disease.
DH is uncommon, but it is important because it is the one rash directly recognized as a manifestation of celiac disease.
Now that you understand DH, several other skin conditions appear more often alongside celiac disease. We only have space to talk about one: atopic dermatitis.
People with celiac disease may be more prone to atopic dermatitis, commonly called eczema. One large adult celiac cohort found atopic dermatitis in 3.8% of people with celiac disease compared with 1.3% of their spouses.
Eczema can sometimes resemble DH, but it is a different condition with a different cause and different treatment. It commonly causes dry, inflamed, itchy, or scaly skin and tends to flare and settle.
Ordinary eczema is not automatically caused by gluten and should not be assumed to improve simply because someone starts a gluten-free diet. Research supports an association between eczema and celiac disease, but that does not establish gluten as the cause of the eczema.
Here’s the bottom line: The skin is the largest organ in the body.
It cannot absorb gluten and activate celiac disease, but it can still reflect the immune activity, autoimmune overlap, and nutritional effects that sometimes accompany celiac disease.
A rash should not automatically be labeled “the celiac rash,” and it should not automatically be blamed on gluten touching the skin. But if it is bothersome, please see a doctor to get appropriate treatment.
Remember, this is not medical advice—just a girl on the internet helping you understand your celiac disease a little better.
So, go live your gluten-free life with a little more knowledge and hopefully a little less fear.
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