<<Disclaimer: Verify this information before applying it to your situation.>>
 
John Wiseman <JWISEMAN @ trentu.ca> wrote:
 
>I recall quite recently some discussion of DH, where it was stated that DH
>eruptions were due to gluten deposits under the skin--I was a bit too quick
>with the delete key, so may have that wrong.  If that is, in fact, the case,
>where would the gluten come from, if the person is on a strictly gluten-free
>diet?
 
I thought the following post from the early days of our list (available from
the archives) had a good overall summary, plus it deals with the point that
even after a celiac goes on a strict GF diet, it can take a very long time to
clear out the gluten
 
Bill Elkus
Los Angeles
------------------------------------------------------------------------------
Date:         Sat, 10 Dec 1994
From:         "J. Murray"
 
In response to your questions about DH, The following represents my views
about this curious and very itchy condition.
In general DH is a severely itchy skin condition that often starts
abruptly, affecting the elbows knees buttocks and scalp and the back. It
usually starts as little bumps that can become tiny blisters and then
aare usually scratched off.  It can occur in one spot only but usually
occurs in many differnt areas.  The condition is related to the deposit
under the skin of IgA deposits.  These occur in response to the ingestion
of gluten iun the diet.  However once deposited there, they are only
slowly cleared by the body even when the individual is gluten free.
While most individuals with DH do not have obvious GI symptoms almost all
have some damage in their intestine. They the potential for all of the
nutritional complications of celiac disease.
The diagnosis is made by taking a skin biopsy and preforming
immunoflorescence studies on it ( a specialised type of stain in major
laboratories)  The test is usually reliable but it takes a signifigant
dedication to detect early cases where there is a short history of rash
rather than years or months of rash.
It is unusual to develope DH after the the start of a GFD for CD.  About
5 % of CD patients will develope DH usually in the first 6-12 months.
This probably reflects the long lasting nature of the deposits under the
skin.
treatment for DH is 2 fold.
Remove the cause Gluten
suppress the skin response with drugs Dapsone or some other sulphones
The latter is the most common treatment used as it is rapidly relieves
the the itch.  However there are some side effects associated with these
mediacations and they need to be taken under mediacal monitoring with
blood tests to detect side effects.
It is my practise that DH should be treated with a GFD for life and use
of drugs to get immediate relief in the short term.  It is usually
possible to get pateint off the dapsone after several months of a strict
GFD.
The most common complication of DH is scarring which ususally fades with
time. Occassionally there can be secondary infection from scratching.
There is probably a slightly increased chance of malignancy in DH not on
a gfd diet.
Several physical triggers are known to set off an attack of DH.
especially exposure to iodides and bromides which are contained in
household cleaners.
A very good reference for DH is available from  the GIG in washington.
Joe murray