dermatologic disorders
Dermatitis Herpetiformis
Key Points
Almost all patients who have dermatitis herpetiformis, even if they have no gastrointestinal symptoms, have histologic evidence of celiac disease and are at risk of small-bowel lymphoma. Because itching is intense and skin is fragile, vesicles may all be broken and thus not evident on examination. Confirm the diagnosis with skin biopsy, direct immunofluorescence testing of a lesion and adjacent normal-appearing skin, and serologic tests. Usedapsoneor an alternative drug (eg, sulfapyridine) to control skin manifestations initially. Have patients try to maintain long-term control with only a strict gluten-free diet so that drug therapy can be stopped. 