Dermatitis Herpetiformis

Background

• Dermatitis herpetiformis is an uncommon, symmetrical vesiculo-bullous disorder which mainly affects the extensor surfaces.
• Usually presents in 3rd/4th decade and more common in men (2:1).
• Most cases are associated with Coeliac disease (jejunal villous atrophy) (1 in 10 will also have a family history)
  • NB symptoms of this may be mild or even absent
  • Anti-endomysial antibodies are usually present and skin biopsy often shows IgA deposition along the dermal papillae

Presentation

• Blisters are rarely found intact (usually excoriated) commonly on the knees, elbows, buttock, scalp and, occasionally, trunk
• Extremely itchy
• Skin may be normal or erythematous

Investigations

• As for coeliac i.e. antiendomysial antibody, gliadin antibody
  • May also have a mild anaemia (may be micro-, macro-, or normo-cytic)
• Immunofluorescence (IgA deposition)

Management

• Gluten free diet
• Dapsone (antimicrobial cream)
  • Or ultrapotent steroids

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