Dapsone is an effective initial treatment in most people and is the initial drug of choice to alleviate the rash and itching. Itching is typically reduced within 2–3 days, however, dapsone treatment has no effect on any intestinal damage that might be present. After some time on a gluten-free diet, the dosage of dapsone usually may be reduced or even stopped, although this may take many years. Dapsone is an antibacterial, and its role in the treatment of DH, which is not caused by bacteria, is poorly understood. It may cause adverse effects, especially hemolytic anemia, so regular blood monitoring is required. Alternative treatment options
For individuals with DH unable to tolerate dapsone for any reason, alternative treatment options may include the following:

colchicine
lymecycline
nicotinamide
tetracycline
sulfamethoxypyridazine
sulfapyridineCombination therapy with nicotinamide and tetracyclines has been shown to be effective and well tolerated in some individuals who cannot tolerate dapsone or live in places where dapsone is not readily available. While the mechanism of action of tetracyclines and nicotinamide in DH is unknown, it is speculated to be due to their immune-modulating effects.Topical steroid medications are also sometimes used in combination with dapsone and a gluten-free diet to alleviate the itchiness associated with the rash. Prognosis
Dermatitis herpetiformis generally responds well to medication and a strict gluten-free diet. It is an autoimmune disease, however, and thus individuals with DH are more likely to develop other autoimmune conditions such as thyroid disease, insulin-dependent diabetes, lupus erythematosus, Sjögrens syndrome, sarcoidosis, vitiligo, and alopecia areata.
There has been an association of non-Hodgkin lymphoma in individuals who have dermatitis herpetiformis, although this risk decreases to less than the population risk with a strict gluten-free diet.Dermatitis herpetiformis does not usually cause complications on its own, without being associated with another condition. Complications from this condition, however, arise from the autoimmune character of the disease, as an overreacting immune system is a sign that something does not work well and might cause problems to other parts of the body that do not necessarily involve the digestive system.Gluten intolerance and the bodys reaction to it make the disease more worrying in what concerns the possible complications. This means that complications that may arise from dermatitis herpetiformis are the same as those resulting from coeliac disease, which include osteoporosis, certain kinds of gut cancer, and an increased risk of other autoimmune diseases such as thyroid disease. The risks of developing complications from dermatitis herpetiformis decrease significantly if the affected individuals follow a gluten-free diet. Epidemiology
Global estimates of the prevalence of dermatitis herpetiformis range from 1 in 400 to 1 in 10,000 people. Individuals of Northern European descent are most likely to be affected and estimates of the rates of DH in British and Finnish populations range from 30 in 100,000 to 75 in 100,000 people, respectively. The annual incidence rate of DH in these populations range from 0.8 to 2.7 per 100,000.People of all ages may be affected, although the mean age at diagnosis varies between 30 and 40 years of age.