What are the differences between dermatitis herpetiformis and eczema?

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This section provides a brief overview of both conditions.

Dermatitis herpetiformis

Dermatitis herpetiformis is a chronic autoimmune condition that affects about 10% of people with celiac disease. Autoimmune means that a person’s immune system mistakenly treats some of their body’s own cells like invading pathogens. Dermatitis herpetiformis affects the skin.

Eczema

Eczema is also a chronic condition that affects a person’s skin. It leads to a damaged outer skin barrier, which makes people more likely to develop skin infections. It can also cause dry skin.

This table compares some key symptoms of dermatitis herpetiformis and eczema, marking those that occur with a cross.

Eczema and dermatitis herpetiformis have a few common symptoms. However, overall, the conditions present rather differently.

Dermatitis herpetiformis

Some of the main symptoms of dermatitis herpetiformis include:

• blistering
• redness, in light skin
• extremely itchy skin
• raised skin
• skin lesions due to picking at the skin
• red or purple spots on the palms or soles

Healthcare professionals characterize dermatitis herpetiformis by the specific areas of the skin that it typically affects. The rash often forms on skin surfaces that exist outside of a joint. Some common sites of dermatitis herpetiformis include:

• elbows
• knees
• buttocks
• scalp

Some people with dermatitis herpetiformis also experience dental problems, such as enamel pits.

Eczema

Eczema has various possible symptoms, which include:

• a rash
• itchy skin
• raised skin
• thick skin
• blistering

As a paper in the Journal of Clinical and Aesthetic Dermatology explains, eczema presents somewhat differently in different skin tones. For instance, in people with light skin, eczema is likely to present with redness and skin plaques.

These symptoms are less common in people with dark skin, who are more likely to experience papules, skin thickening, and changes in skin pigmentation.

Learn more about eczema on skin of color.

The causes of eczema and dermatitis herpetiformis also differ.

Dermatitis herpetiformis

Dermatitis herpetiformis forms as a result of gluten hypersensitivity. Scientists consider dermatitis herpetiformis to be a manifestation of celiac disease.

Researchers have not determined the exact cause of dermatitis herpetiformis. However, there is evidence that genetics play an important role. Some genetic mutations make it harder for the body to process gluten.

Eczema

Although researchers remain uncertain about the exact causes of eczema, several factors are likely to play a role, including:

• certain genetic mutations
• inflammation associated with immune system responses to various triggers
• low production of skin barrier proteins

Eczema is a chronic condition that can suddenly worsen. Eczema flare-ups often occur in response to external triggers. Common eczema triggers include:

• high humidity
• high heat
• dust mites
• certain foods, such as fish, soy, and milk
• some chemicals and irritants, including soaps
• some fabrics, such as acrylic and wool
• stress
• infection

Eczema flare-ups may also arise for no apparent reason.

Doctors treat eczema and dermatitis herpetiformis in different ways.

Dermatitis herpetiformis

According to research, a gluten-free diet is essential for treating dermatitis herpetiformis. By strictly keeping to this diet, people may eventually experience no symptoms of dermatitis herpetiformis.

However, it is important to note that the symptoms may persist for some years, even with a strict gluten-free diet. During this time, doctors may recommend medications to help manage the symptoms. A common drug is dapsone (Aczone), which individuals with dermatitis herpetiformis may take once a day following a doctor’s advice.

Eczema

Eczema is an incurable condition. However, researchers have found that people can manage the symptoms. This often involves several strategies:

• identifying and avoiding eczema triggers, which reduces the likelihood of flare-ups
• topical anti-inflammatory drugs to reduce the severity of eczema flare-ups
• other medications, including oral Janus kinase inhibitors and biologics, such as dupilumab (Dupixent) and tralokinumab-ldrm (Adbry)
• using a fragrance-free moisturizer to hydrate the skin daily

A healthcare professional may also recommend different medications and treatments depending on the severity of a person’s eczema.

Effective treatment requires an accurate diagnosis. Anyone with symptoms of dermatitis herpetiformis or eczema should seek a doctor’s advice.

Dermatitis herpetiformis

A gluten-free diet is an important part of treating celiac disease, which is when gluten hypersensitivity leads to intestinal problems. Dermatitis herpetiformis results from gluten hypersensitivity.

If a gluten-free diet is not effective, a healthcare professional may recommend taking medication to help manage the symptoms of dermatitis herpetiformis. The options may include topical steroids.

Eczema

Research has shown that eczema is a risk factor for other atopic conditions. These conditions occur in response to allergens. People with eczema have a 50% chance of developing asthma. They also have a 75% chance of developing hay fever.

As eczema damages the skin, people with this condition are more likely to develop skin infections. In rare cases, some of these infections can be serious. For instance, eczema herpeticum and eczema cosackium infections are potentially life threatening.

Learn more about infected eczema.

Below are answers to some of the most common questions about dermatitis herpetiformis and eczema.

Does dermatitis herpetiformis look like eczema?

They can look similar. For example, both conditions can cause red or discolored patches and raised skin.

Is eczema a symptom of celiac disease?

No, eczema is not a symptom of celiac disease. Dermatitis herpetiformis, which is similar to eczema, is a skin manifestation of celiac disease.

How long does it take for dermatitis herpetiformis to clear up?

With a gluten-free diet, dermatitis herpetiformis may resolve within several months. However, in some cases, the condition can last for a few years.

Dermatitis herpetiformis and eczema are chronic skin conditions that can cause itchy skin. However, whereas eczema can arise in response to several triggering factors, dermatitis herpetiformis is always due to gluten hypersensitivity.

A person should speak with a doctor if they think that they may have eczema or dermatitis herpetiformis. The doctor can make an accurate diagnosis and recommend an appropriate treatment plan.