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Many, many thanks to everyone who responded, and here is the long-overdue
summary! It looks like my brother will be seeking a skin biopsy! Here are
some representative replies:
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I would suggest a CD biopsy by an expert GI MD.  And then a strict GF diet.
That means also vitamins, watch the topical creams,etc. He should be free
from symptoms within several weeks. Remeber the blood tests are 25% false
negatives.
My 16 year old daughter is celiac, soy, casein, groundnuts, citrus fruits,
fish and soyfish, lamb and goat allergies and she also had those "flat
warts" on her left hand just above the thumb.  Itched like the devil so
badly she picked the tops off!  Gross!  Dr., (of course) gave her steroid
cream and said that wer
en't DH.  We tossed the prescription and went to the
naturopath.  She looked and said, food allergy,  another one!  We removed
legumes and a sneaky source of soy and they were gone! That was one year
ago.
+++++++++++++++++++++
 ... DH is seldom totally "classic".  I started with classic elbows and
knees. Even my dermatologist has doubts about some of the places I claim,
but the simple fact is these spots act up and then calm down with accidental
gluten exposure while classic spots are doing the same thing.
In my opinion, the knuckles are a dead giveaway that it is DH. The skin on
the knuckles is very much like knee and elbow skin, which IgA (the itch
causer) seems to prefer. Also, "raised bumps" and "itchy" are another dead
giveaway if you have CD in the family.  If the bumps have clear fluid inside
when you "pop" them...
Also, Face [yes]  anywhe
re on the head is game for DH. I find that eyelids,
cheeks, scalp, and especially behind the ears are popular. Neck [yes]  Some
of the hugest things have happened on my neck. Back of Hands [yes]  This is
a favorite place for DH blisters...fingers too. The blisters seem to have a
slightly different appearance here.
+++++++++++++++
I was originally diagnosed with peri-oral dermatitis and rosacea... but my
skin didn't respond to convential treatment and cleared up when I changed my
diet. I also had some of the more typical food allergy  symptoms -- cancer
sores, sore itchy bumps on my scalp, bumps and cracks at the corners of my
mouth... as well as all the internal symptoms
++++++++++++
It sounds like your brother may even have hives -- which can also take about
a million forms. One thing that comes to mind is to remind him to avoid
topical products -- shampoos
, conditioners, lotions, aftershaves, lip balms,
etc. containing wheat protein, wheat germ oil, or grain alcohol (unless the
manufacturer specifies which grain...) The location of his breakout makes me
suspect an aftershave or sunscreen, or something similar. Something applied
with his hands to his face and neck that leaves some
residue on his hands... Also, now that I think about it, I've had a similar
reaction to the one you describe to a sunscreen. It was on my arms and
ankles, though. And it looked like a rash of flat warts and itched and
stung. I actually thought it might be poison oak for a few days...  I don't
know if anything in here helps... just my thoughts.
++++++++++++++
My husband has celiac -- blood test and biopsy diagnosed.  He does NOT have
DH.  However, he suffers from itchy rashes that drive him nuts.  (They look
like prickly heat to me.)He does have mul
tiple allergies -- his blood tests
for allergies showed all kinds of pollens, dust, and many foods.   He has
been taking shots for the environmental allergies for years and they do help
him immensely. He has been GF for nearly 3 years.  I think that the rashes
are not as bad, but still there.  We have been to several dermatologists and
the only thing we have come up with after 8 prescriptions for oral meds and
creams and gels is the following:
Remove all dyes and fragrances from topical items.  (We also use GF
products.)
We use All Free detergent, no fabric softener, Clorox bleach, Dove bar soap
for sensitive skin, Free n Clear shampoo, Vanicream (body cream).  The
Vanicream seems to keep the skin moist and lessen the itching.
(This one is a remedy from another listmember.)  Apply Tea Tree Oil at
bedtime full strength to the itchy area and then covered with a white tee
shirt to keep it from staining
 the sheets.  Then, in the morning, take a
warm shower and apply the Vanicream.   This seems to help lessen the itching
+++++++++++++++
A dermatologist can raise DH blisters to biopsy by applying a strong rx
solution of iodine to the skin.  Iodine will only cause DH to produce
blisters.  Often there are no blisters to biopsy because one has itched them
off before they erupt.
+++++++++++++
I also had a severe reaction to dapsone when being treated for the second
outbreak which was fairly recently.  This time it was a relatively minor
outbreak on knees and elbows only.  We think it was most likely from daily
exposure to a gluten containing vitamin that I was unaware of as containing
gluten.  Anyway, apparently I am allergic to sulfides and dapsone is a sulfa
drug.  I broke out in a much worse rash, very itchy, raised and purplish on
my arms and legs, tops of feet
 and backs of hands.  It is my understanding
that allergic reactions are common on the backs of the hands.  Is your
brother taking a med he could be allergic to?  This got very confusing to
try and figure out as at first I got quickly better from the dapsone only to
get a far worse and ugly rash in about 2 weeks.
I also get Atopic Dermatitis.  It is hard to tell the difference between the
DH and the  atopic Dermatitis, both are itchy and red.  I have had 4
biopsies over the years, twice it was DH and twice it was the Atopic
Dermatitis.  With the Atopic Dermatitis though I get it on the arms, legs,
but mostly the trunk and also the back of my head and neck
++++++++++++++
I have DH on my elbows and knees, but also occassionally get an outbreak on
my knuckles. Your brother's dermatologist should be able to do a biopsy and
diagnose the rash if it is DH.
yes, those are logical places for DH
, I have it on my back, knuckles,
elbows, calves... But only rarely now, I try to stay as GF as possible.. I
was driven crazy by the itching until I got the the SIXTH doctor who
diagnosed it. Put me on dapsone with monitoring for anemia... itis an
anti-inflamatory drug and can be hard on the liver . Over a period of a year
it got better and better and I weaned myself off the dapsone as needed. was
taking two the three tabs a day (100 mg. tabs) even got the the point of
cutting the tabs in half at
the end.
++++++++++++
...all celiacs are different. So some do have DH in places other than the
normal "pressure points." Try this website. It's designed to help docs
diagnose celiac, and it has good photos of DH:
http://www.aafp.org/afp/980301ap/pruessn.html
Any decent dermatologist should be able to biopsy the rash and tell you for
sure if it's DH. It's much easier th
an testing for celiac in general.
Furthermore, if he does have DH for sure, he doesn't need to be tested
further. DH is prima facie evidence of celiac. Best wishes
++++++++++++
It sounds like your brother is having a DH experience much like the one I
had. After spending a year in Nepal eating rice and lentils, I came home to
the States and back to the sandwiches and bagels I had missed so dearly.
Well, after being back for about a month, I started getting the same 'flat
warts' all over my face and neck. My GP couldn't figure it out and neither
could my dermatologist. Finally, I had the biopsy and realized it was DH
with celiac. ... but I definitely had an experience with DH on the face and
neck . . .
+++++++++++++++
I am a DH with much of the same symptoms over the years prior to Dx by
biopsy. The easiest symptom alleviation may well be from oil of tea tree
 10
drops in 1 Oz of olive oil.  Applied every 12 hours brings much relief for
me.  The IgA needs 18 - 24 months to leave the system. The state of the art
Rx for this IgA reaction is OLUX foam, 0.05% (clobetasol propionate).  The
locally available (USA) version of this med is
US$95 per 100 GM of foaming wonder.  As a DH patient 4 months' post Dx, I
have small need of the foam, but the relief from my own immune system's IgA
is priceless.  Evidently I have some 18 - 20 months more of Gluten free
living to go before I stop going slowly insane from my reaction.  Because I
work in the high tech (and high turmoil) sector, I have been without
employment, health insurance and income of some months.  I found an
alternative to deciding whether to feed my family or stop itching on the web
at www.skinmed.com and I thought I might pass it on through this
organization.
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