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Skin Care and Diseases

Dermatitis herpetiformis vs Seborrheic derma

10/28/2004

Question:

hello is there a way to know if you have definitely one or the other? I have it on my scalp and it was believed to be DH (my mom said I had cradle cap as a baby but my sister is celiac and I recently have had gastro problems and now I am being to wonder if this may be related. Thank you

Answer:

It is possible to have both seborrheic dermatitis and dermatitis herpetiformis at the same time.  The distributions are quite different.  The morphology or form of the lesions are also quite different.  The lesions of dermatitis herpetiformis are papulovesicles on a red base frequently seen around the wrists, back, torso and extremities.  Whereas seborrheic dermatitis involves the scalp, central face, and may involve the gluteal cleft and the axillae.  Seborrheic dermatitis (dandruff) has often been associated with yeast overgrowth on the skin and is frequently controlled with Nizoral shampoo, Nizoral cream, and occasionally low-potency steroids topically.  Dermatitis herpetiformis is associated with gluten intolerance within the bowel.  Gluten is a component of wheat which is the most common source.  It may or may not be associated with gastrointestinal symptoms, but clearly removal of gluten from the diet often controls the dermatitis herpetiformis.  In addition to gluten restriction it may be necessary to add Dapsone to the regimen to render the patient free of symptoms. 

You wondered whether or not your stomach problems were related to your skin.  I would talk to a gastroenterologist or to a knowledgeable internist or family physician about gluten intolerance.  If you develop skin lesions, a biopsy for H&E and for immunopathology would be helpful in determining the precise nature of the skin eruption.

I hope this helps.  In any event, if the above listed physicians are not available, a board certified dermatologist can very clearly distinguish between the two disease processes. 

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Response by:

Charles L Heaton, MD
Professor
College of Medicine
University of Cincinnati