The gut may also be affected by this allergy; this is called gluten-sensitive enteropathy (GSE) or celiac disease. Some people only have the GSE, some have GSE and DH and some just DH. It is not known why some develop on and not the other. There are cases of GSE that have turned cancerous (malignant lymphoma) so an evaluation by a gastroenterologist (a medical doctor specializing in the stomach and intestines) is prudent. Diagnosis of DH usually requires at least one skin biopsy, and sometimes a blood test (looking for anti-gliadin, anti-reticulin and anti-endomysial antibodies). Once confirmed, treatment will be lifelong, although severity may wax and wane. Complete elimination of gluten is curative, but improvement takes months. The gluten-free diet is very difficult, as tiny amounts of gluten are in almost all restaurant and prepared foods, gum wrappers and the like. Cutting down on wheat and gluten may reduce the amount of medication needed, but will not be curative.
Fortunately, there is a very effective treatment. Dapsone is a drug that will improve DH in days. Because there can be side effects, the dose of Dapsone is usually started at a small amount, and then raised up over a few weeks until all symptoms are suppressed. Dapsone may have adverse effects, so weekly or bi-weekly blood tests will be needed for the first three months. There are a few alternative treatments if Dapsone cannot be used (sulfapyridine, tetracycline), however these do not work as well.
(published with permission in writing from:http://www.aocd.org)
