Celiac Disease and Skin Manifestations, Connection Explained

by | Jan 2, 2023 | Blog, Genetics, Personalized Medicine, skincare

Celiac disease is more than just an autoimmune condition involving the digestive system. For some, it also manifests on the outside in the form of skin issues: rashes, sores, and inflammation can all occur due to celiac disease. Before addressing any potential skin abnormalities related to celiac disease, you must understand this condition and how it affects your body.

In this blog post, we’ll look at exactly how a diagnosis of celiac disease may manifest through signs and symptoms on your body’s outer layer. This will allow for better recognition of potential skin problems associated with autoimmune disorders, so they can be caught before they progress too far!

 

What is Celiac disease?

 

Celiac disease is an autoimmune disorder that is triggered by the consumption of gluten. It affects 0.5 to 1 percent of the general population in many parts of the world. Those with celiac are unable to properly digest gluten, which could damage their small intestine over time.

Celiac disease can cause a wide range of symptoms, which may vary from person to person.

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Some common signs and symptoms include:

 

  • Abdominal pain and bloating
  • Diarrhea or constipation
  • Fatigue
  • Weight loss or gain
  • Anemia
  • Rash on the skin (dermatitis herpetiformis)
  • Joint pain and infertility

Other less common symptoms include:

  • Tingling or numbness in the legs and arms
  • Mouth ulcers
  • Tooth discoloration (enamel loss)
  • Missed menstrual periods

 

What is the pathogenesis of Celiac disease?

 

The pathogenesis of the Celiac disease is a complex and multifactorial process. It involves the interaction between genetic, environmental, and immune factors that lead to an inappropriate inflammatory response in the small intestine when consuming gluten-containing foods.

The primary triggers for this aberrant response are dietary proteins found in wheat, rye, and barley (gluten), which contain prolamins (glutenin and gliadin) that are resistant to breakdown in the small intestine. When these dietary proteins are consumed, they contact specific components of the host’s immune system, resulting in a series of immunological events, including activation of T lymphocytes and production of autoantibodies.
The activation of T lymphocytes results in the release of pro-inflammatory substances such as interferon-gamma, tumor necrosis factor-alpha, and other cytokines. These substances trigger a cascade of events that lead to an inflammatory reaction in the small intestine, damaging the mucosal epithelium and attendant histological changes.

The presence of autoantibodies against transglutaminase-2, endomysium, and gliadin are also associated with the pathogenesis of the Celiac disease, as they may activate both innate and adaptive immune responses that contribute to inflammation and tissue damage. The exact mechanism by which these antibodies cause tissue injury is still unknown, but they are thought to activate inflammatory cells, such as macrophages, that can further exacerbate the damage.

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What are some common skin manifestations of Celiac disease?

 

Common skin manifestations of celiac disease include dermatitis herpetiformis, acrodermatitis enteropathica, and gluten-sensitive dermatoses.

Dermatitis herpetiformis, skin manifestation caused due to Celiac Disease.

Dermatitis herpetiformis is an intensely itchy rash that causes itchy bumps and blisters on your skin as a result of gluten sensitivity.

Dermatitis herpetiformis is an intensely itchy rash that causes itchy bumps and blisters on your skin as a result of gluten sensitivity.

  • Dermatitis herpetiformis (DH) is an intensely itchy rash that arises primarily on the knees, elbows, buttocks, and scalp but can occur anywhere on the body. The rash comprises small bumps, blisters, and flat lesions.
  • Acrodermatitis enteropathica (AE) presents a symmetrical rash on the face, hands, feet, and around body orifices. The rash may be scaly or red in appearance with an intense itch.
  • Gluten-sensitive dermatoses are skin conditions such as eczema, psoriasis, and urticaria that the ingestion of gluten may exacerbate.

Other skin manifestations can include alopecia areata, vitiligo, and changes in skin pigmentation. In addition, celiac disease has been associated with a higher risk of certain skin cancers. It is essential for individuals with celiac disease to monitor their skin for any changes and to seek medical advice if they notice anything unusual. Early diagnosis and treatment are crucial to managing the condition.

 

How is celiac disease diagnosed and treated?

 

Celiac disease is typically diagnosed through medical history, physical exams, and laboratory tests.

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Medical history and physical exam

During an initial appointment with your doctor, they will likely ask you questions about your medical history and symptoms to determine if celiac disease is present. If the diagnosis is still uncertain after this discussion, they may order a blood test to check for antibodies associated with celiac disease.

 

Laboratory tests

If the initial screening is positive, your doctor may recommend additional blood tests to look for certain antibodies specific to celiac disease. These commonly include tTG-IgA (anti-tissue transglutaminase IgA), EMA (anti-endomysial antibody IgA), and DGP (anti-deamidated gliadin peptide).

If the laboratory tests are positive, your doctor may recommend an intestinal biopsy for a definitive diagnosis. During this procedure, a small tissue sample will be taken from the lining of your small intestine and sent to a laboratory for analysis. This will help confirm the presence of villous atrophy, an indicator of celiac disease.

Finally, your doctor may recommend genetic testing to check for specific genes associated with celiac disease. The two most common are HLA-DQ2 and HLA-DQ8.

Once your doctor has enough information to diagnose, they can recommend the right treatment plan for you. This may include dietary changes and medication to help control your symptoms.

 

Are there any long-term effects of untreated celiac disease on the skin or other organs in the body?

 

One of the most common long-term effects of untreated celiac disease on the skin is Dermatitis Herpetiformis (DH) – a chronic, extremely itchy skin condition. DH typically appears as small clusters of raised bumps or blisters that can appear anywhere on the body, but it most commonly appears on the elbows, knees, back, and buttocks.

Other long-term effects of untreated celiac disease on the skin include Oral Ulcers, which are painful sores in the mouth that can make eating or speaking difficult; alopecia (or hair loss); and photosensitivity, in which the skin becomes very sensitive to sunlight.

Untreated celiac disease can also have long-term effects on other organs in the body. People with untreated celiac disease are more likely to develop anemia, osteoporosis, infertility, neurological complications like epi/gastric seizures, and even certain types of cancer.

In addition, untreated celiac disease can also cause digestive issues such as chronic constipation, diarrhea, and malabsorption of nutrients. Malabsorption means that the body cannot absorb all the essential vitamins, minerals, and other nutrients from food, leading to various health complications, including fatigue, malnutrition, and even weight loss.

It’s important to note that the long-term effects of untreated celiac disease can vary from person to person, depending on age, health history, lifestyle factors (such as diet and exercise), and other environmental influences.

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How can people with Celiac disease manage their condition to minimize skin problems?

 

People with celiac disease can manage their condition to minimize skin problems in several ways.

They must adhere to a strict gluten-free diet, which will help reduce the inflammation caused by ingesting gluten and other proteins found in wheat, barley, and rye. Doing so may improve the appearance of skin rashes and reduce their severity.

Additionally, avoiding other foods that can cause an allergic reaction, such as dairy and soy, is recommended to manage skin problems related to celiac disease.

In addition to dietary changes, people with celiac disease should also speak with their healthcare provider about any medications they are taking that could be causing skin reactions. Certain antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) can cause a range of skin reactions, including rashes, hives, and itching. These medications should be avoided or used with caution to help minimize skin problems.

Finally, people with celiac disease should also practice good hygiene to prevent flare-ups of skin problems. This includes showering regularly to remove any irritants that may be causing the skin reaction, avoiding tight-fitting clothing, and using a gentle cleanser on the affected area. Also, moisturizing creams can help soothe irritation and relieve itching or burning sensations.

By following these guidelines, people with celiac disease can help manage their condition and minimize the skin problems caused by it. However, if any of these treatments are ineffective or symptoms persist for more than a few days, individuals should seek medical advice to determine the best course of action.

 

Conclusion

Celiac Disease is a complex condition that can lead to skin manifestations in some individuals. A wide range of skin manifestations has been documented as potentially associated with Celiac Disease, including eczema, psoriasis, alopecia areata, and dermatitis herpetiformis. It is essential to consult with a medical professional if you are experiencing any of these conditions to thoroughly investigate potential causes and ensure that appropriate treatment is given.

 

 

References

  1. Caproni, M., Bonciolini, V., D’Errico, A., Antiga, E., & Fabbri, P. (2012). Celiac Disease and Dermatologic Manifestations: Many Skin Clue to Unfold Gluten-Sensitive Enteropathy. Gastroenterology Research and Practice, 2012, 1–12. https://doi.org/10.1155/2012/952753
  2. Abenavoli, L. (2006). Cutaneous manifestations in celiac disease. World Journal of Gastroenterology, 12(6), 843. https://doi.org/10.3748/wjg.v12.i6.843
  3. Humbert. (2022). Gluten intolerance and skin diseases. European Journal of Dermatology: EJD, 16(1). https://pubmed.ncbi.nlm.nih.gov/16436335/

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