If you have tried numerous acne treatments, hormone regulations, skincare products, and cosmetic procedures, and nothing has helped, you might think you have a gluten rash. But are gluten intolerance and acne related? In this article, you will learn what gluten intolerance is, whether it causes acne or not, and does gluten-free diet help to reduce symptoms.
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What Is Gluten?
Gluten is a group of proteins found in wheat, rye, barley, and triticale, and their products: bread, pasta, beer, spelt, bulgur, and baked goods. Also, gluten can be found in many other foods (often processed) that are not even related to grains: soups, sauces, and salad dressings. Even sausage and French fries may contain gluten.
Oats are considered naturally gluten-free but actually are often contaminated when grown, kept, transported, and processed near gluten grains.
Gluten holds up the shape of foods and makes the bread puff and stretchy (like pizza dough). It acts like the glue of the food.
Why Is Gluten Important for our Health?
Gluten-containing grains are rich in fiber and essential nutrients, such as B group vitamins, iron, and magnesium.
Gluten also acts as a prebiotic, feeding the beneficial bacteria in our body, such as bifidobacteria in the gut. The beneficial bacteria protect the gut from inflammatory diseases, irritable bowel syndrome, and even cancer.
It was also estimated that people consuming whole grains, including wheat, were less often diagnosed with heart disease and type 2 diabetes, less often experienced a stroke, and had lower mortality rates.
Although there is still too little research, we can conclude that gluten is essential for healthy bodies and living.
Gluten Intolerance, Celiac Diseases, and Wheat Allergy – the Three Problems of Gluten
Despite all the benefits of gluten, some people experience gluten side effects. There are three major gluten problems:
1. Celiac Disease
Celiac disease is an autoimmune, genetic disorder affecting 1.4% of people globally. Its incidence is rising every year. It is thought that most people are undiagnosed for celiac disease or misdiagnosed for other conditions.
It is a genetic disorder, so people inherit it from close relatives. Sometimes celiac disease becomes active after pregnancy, emotional stress, viral infections, or surgery.
Celiac disease is characterized by an overactive immune system and elevated antibodies that damage the small intestine’s tiny projections (villi), making it smaller and leading to the malabsorption of nutrients, diarrhea, constipation, bloating, infertility, anemia (due to malabsorption), and nervous system damage.
2. Gluten Intolerance
Gluten Intolerance, also called non-celiac gluten sensitivity or gluten sensitive enteropathy, is not caused by an overactive immune system, and the antibodies are not elevated. It means that there is no intestinal damage.
Gluten-containing foods cause gluten intolerance.
However, the symptoms are similar to celiac disease: diarrhea, constipation, bloating, fatigue, nausea, etc.
The problem with gluten intolerance is that there is no diagnostic test for it. It can be diagnosed only by symptoms and negative tests for celiac disease and wheat allergy.
3. Wheat Allergy
It is an allergy to one or more wheat proteins (not only gluten): albumin, globulin, gluten, and gliadin. It is diagnosed by immunoglobulin E (IgE) blood test and food challenge (if the test is negative, it may still be gluten sensitivity).
As with all allergies, wheat allergy symptoms include itchiness and swelling (throat, eyes), hives, shortness of breath, cramps, diarrhea, and anaphylaxis.
Gluten Is Not the Only Protein in Wheat to Cause Problems
Scientists have found a small group of proteins in wheat called amylase-trypsin inhibitors (ATIs), which help the wheat defend itself from parasites. They also trigger an immune response in the human gut which can spread beyond the digestive system.
Internal inflammation is also linked to acne. So maybe not gluten, but ATIs cause gluten acne (how weird!).
ATIs can worsen rheumatoid arthritis, asthma, lupus, multiple sclerosis, and inflammatory bowel syndrome and cause inflammation in the kidneys, spleen, and lymph nodes. These proteins usually do not cause health conditions but worsen preexisting diseases.
Researchers also think that ATIs can contribute to non-celiac gluten sensitivity (aka gluten intolerance). Maybe this is the cause why persons experiencing similar to gluten caused symptoms test negative for celiac disease! Because ATIs are not gluten!
What Is Gluten Rash?
Gluten rash, also known as dermatitis herpetiformis, is a skin condition caused by gluten consumption. It affects 10% of people with celiac disease and is more common in people from northern Europe.
The symptoms of gluten rash include red, itchy skin, burning sensation, small clustered papules, and sometimes blisters or bumps. The most common locations of the gluten rash are elbows, knees, buttocks, back, and scalp, but sometimes it may affect the face.
The skin is itchy, and people with gluten rash often scratch the skin, leading to excoriations and scars.
When lesions of gluten rash resolve, post-inflammatory hyperpigmentation (dark spots) or hypopigmentation (white spots) may be visible on the skin.
Are Gluten Intolerance and Acne Linked Together?
Gluten is linked to various skin conditions, such as dermatitis herpetiformis, which we discussed above, and eczema, psoriasis, hives, alopecia areata, dry skin, and chicken skin.
But when it comes to acne, there is no scientific evidence that gluten intolerance could cause acne. I do not say gluten does not cause acne. What I say is that we have no proof. Yet! The link between gluten intolerance and acne is still possible. We just need to wait for more evidence.
Many people report reduced acne after going on a gluten-free diet. The improvement of the skin may be due to the following:
- People misdiagnose other skin conditions linked to gluten for acne. Going on a gluten-free diet definitely improves these conditions.
- Gluten is found in high glycemic index foods that increase blood sugar. When the blood sugar increases, insulin is released. Insulin is known to cause skin inflammation and contribute to acne. Reducing gluten in the diet means reducing sugars and clearing skin.
- High glycemic index foods also cause dysbiosis and overgrowth of yeast as they are fed by sugar. Yeast can cause internal inflammation associated with acne. It may also contribute to another type of acne – fungal acne.
- Celiac disease causes malabsorption of essential nutrients, especially B-group vitamins found in grains. This may lead to vitamin deficiency acne. Replacing gluten-containing grains with gluten-free products may provide the body with the essential nutrients, vitamins, and minerals which will clear out acne caused by vitamin deficiency.
- ATIs proteins found in wheat cause inflammation in the digestive tract, which may spread beyond the gut. Inflammation in the gut is a major trigger for acne.
So, if gluten is not linked directly to acne (or at least we don’t know yet), it is found in high glycemic index foods which trigger acne. Cutting out gluten lowers blood sugar levels and helps clear acne. Also, ATIs which are not gluten might be associated with internal inflammation and acne.
What Are the Diagnostic Procedures for Celiac Disease, Gluten Intolerance, and Gluten Rash?
If you suspect that gluten causes skin issues, you must check for gluten intolerance first. The most often performed diagnostic procedures for celiac disease, gluten intolerance, and gluten rash are:
- Blood test for nutritional deficiencies. Usually, people with celiac disease have digestive problems and diarrhea and experience malabsorption of essential nutrients. Therefore, checking the blood for iron, zinc, B group vitamins (especially B12), folate, and calcium is the first diagnostic procedure to perform. Also, it is worth testing for liver function, thyroid hormones (sometimes gluten rash is associated with thyroid dysfunction), and overall blood count.
- Small intestinal biopsy. The biopsy may reveal smaller or flattened villi (tiny projections) of the small intestine, which is characteristic of celiac disease.
- Autoantibodies in the blood. You should consume gluten before the test; otherwise, the test might not show any changes. However, sometimes no changes are found, even if a person has celiac disease. In this case, a small intestinal biopsy would be a better diagnostic procedure.
- Skin biopsy for gluten rash. It is performed under local anesthesia, and a small skin sample is examined under a microscope.
How to Treat Gluten Rash and Wheat Intolerance Acne?
While there is no cure for celiac disease and gluten intolerance, here are some tips to relieve your skin conditions caused by gluten, such as gluten rash:
1. Gluten-Free Diet
Cutting out gluten is the main and only way to target the cause and reduce the symptoms of celiac disease and gluten intolerance and clear out gluten-related skin conditions, such as gluten rash, eczema, psoriasis, or acne.
It would help if you avoided wheat, barley, white rice, triticale, and their products (spelt, bread, baked goods, pasta, beer, bulgur). Also, avoid products containing additives with gluten. The additives that might contain gluten (not always) include modified food starch, maltodextrin, malt-based ingredients, wheat flour, soy sauce, teriyaki sauce, and some emulsifiers.
It is not enough to cut out only gluten-containing foods. Some foods may be contaminated with gluten, so you need to be careful.
Some gluten-free foods include:
- Fresh vegetables and fruits (avoid processed fruit and vegetables as they may contain gluten in additives such as hydrolyzed wheat protein, modified food starch, and malt, also check frozen and dried fruits and vegetables),
- Fresh cuts of meat and fish, seafood (but be careful with breaded or floured meats, sausages, bacon, ground meat),
- Dairy products (be careful with ice cream and other flavored products, such as yogurt or milk),
- Soy products (unflavored tofu, tempeh, edamame, except soy sauce),
- Nuts, seeds, and legumes,
- Oils (except oils with added flavors).
Some grains are gluten-free and safe to eat:
- Oats (but sometimes might be contaminated with gluten, look for gluten-free oats);
- Red, brown, or black rice;
- 2. Probiotics
Probiotics help to maintain a healthy gut and reduce inflammation and overgrowth of yeast. Probiotic supplements or probiotic-rich food will also help to clear out skin conditions.
3. Dapsone or Topical Steroids for Gluten Rash
If you have an active form of gluten rash, an oral antibiotic, Dapsone, might help to reduce symptoms and itchiness.
Topical corticosteroids also help with itching, but they can cause skin thinning, red rash around the mouth, dilated blood vessels, dryness, and other side effects.
4. Gluten Acne Treatment
Gluten or wheat-related acne can be treated by reducing the amounts of gluten-containing foods, supplementing with vitamins and minerals that you might be lacking, and taking good care of your skin. I have covered many acne treatments in this guide to hormonal acne.
Takeaway – Final Thoughts on Gluten Rash and Gluten Acne
As we have discussed above, gluten rash is not gluten acne.
Gluten rash, also called dermatitis herpetiformis, is a skin condition characterized by red itchy skin and small clustered papules or vesicles on elbows, knees, scalp, buttock, and sometimes face. It is caused by gluten consumption.
Gluten acne, on the other hand, is not caused by gluten but rather by high glycemic index foods that elevate insulin levels and stimulate yeast growth. Also, gluten consumption may cause malabsorption of vitamins and minerals, which in turn may cause vitamin deficiency acne. Finally, other proteins in wheat (not gluten) may cause internal inflammation, which can spread beyond the gut and trigger acne on the face (or elsewhere).
To conclude, gluten rash and gluten acne are two different skin conditions with different symptoms and underlying health problems. Gluten acne might not be caused by gluten at all!
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