Diagnosis: Dermatitis herpetiformis
Intensely pruritic, grouped papulovesicles on extensor surfaces (elbows, knees, buttocks). GI symptoms may be absent. Evaluate for celiac disease with tissue transglutaminase antibodies.
Dapsone 50-150 mg/day (rapid response within days). Check G6PD before starting. Gluten-free diet (GFD) — can reduce or eliminate need for dapsone after months. Monitor CBC for dapsone-related hemolysis and methemoglobinemia.
• Linear IgA bullous dermatosis • Scabies • Eczema/atopic dermatitis • Bullous pemphigoid • Erythema multiforme • Prurigo nodularis • Insect bite reactions
• 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, dermatologist, dermatology, kodachrome