Dermatitis Herpetiformis

Diagnosis: Dermatitis Herpetiformis

Bilateral, symmetrical, grouped papules and minute vesicles, some of them eroded secondary to excoriation.

Clinical Presentation

Bilateral, symmetrical, grouped papules and minute vesicles, some of them eroded secondary to excoriation.

Clinical History

Submitted by Alaa Saad. Originally posted September 21, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Linear IgA bullous dermatosis • Scabies • Eczema/atopic dermatitis • Bullous pemphigoid • Erythema multiforme • Prurigo nodularis • Insect bite reactions

Key Learnings

• Pathognomonic cutaneous manifestation of celiac disease — virtually all patients have gluten-sensitive enteropathy • Classic DIF: granular IgA deposits at dermal papillae tips — this is the diagnostic gold standard • Symmetrical distribution: elbows, knees, buttocks, shoulders, sacrum • Intensely pruritic — vesicles often excoriated by the time of examination • Responds dramatically to dapsone (often within 24-48 hours) • Gluten-free diet is the only treatment that addresses both skin and GI disease • Check G6PD before starting dapsone (risk of hemolytic anemia)

Tags: dermatitis, herpetiformis, alaa saad