A 14-year-old patient with an eczema flare on his elbows, shoulders and buttocks tests positive for celiac disease.
- Dr. Daniel Taylor, Associate professor at Drexel University College of Medicine and director of community pediatrics and child advocacy at St. Christopher’s Hospital for Children, Inquirer.com 1
A 14-year-old patient of mine came in for a routine physical. He had a history of mild eczema and asthma but he was excited to start his summer job as a lifeguard, and then high school in the fall.
His only complaints were intermittent stomach pain for several months and an eczema flare that had been going on for the last few weeks. He was concerned — and self-conscious — especially about his eczema because he had it on his elbows, shoulders, and buttocks, and was facing hours in a swimsuit seated in a lifeguard chair.
He complained that the eczema was more itchy than in the past, and that there were small blisters scattered within the lesions. He wasn’t too concerned about his belly pain, and figured it might be connected with the pressure of starting school, employment, and now his eczema flare.
Other than his skin problems, his physical exam was completely normal including his abdominal exam. On both his elbows, his lower thighs, knees, and buttocks, he had multiple small red bumps with scattered small blisters mixed in.
He had a theory about that, too. “I spend a lot of time gaming” he explained, “and I have my computer on my lap a lot and elbows at the ready position leaning on the chair arms.” He thought that the pressure and friction of this activity could be exacerbating his eczema.
The exam suggested that his growth was slowing down, which was a little unusual because he was starting puberty and this usually causes an acceleration in height.
“Please do something about my eczema” he pleaded. “I start work in two weeks.”
I wrote him a prescription for a high-dose steroid to help with the itching and inflammation, but also sent him to our lab for a few tests.
Louis Duhring was an American physician and professor of dermatology at the University of Pennsylvania until his death in 1913. He was considered a leading authority in American dermatology, and is remembered especially for describing a condition that he called dermatitis herpetiformis.
As the name implies, and as the rash presents, it looks like typical herpes lesions (small blisters) on the skin. What Duhring did not know, and what wasn’t recognized until 1967, is the association with one of the most common gastrointestinal disorders worldwide, gluten sensitive enteropathy, or more commonly, celiac disease.