Dermatitis herpetiformis

Diagnosis: Dermatitis herpetiformis

Dermatitis herpetiformis

Clinical Presentation

Dermatitis herpetiformis

Clinical History

Submitted by Ellie Goulding MD. Originally posted January 23, 2017.

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, ellie goulding md