Dermatitis Herpetiformis

Natalia Plotnikova, BS; Jami L. Miller, MD


Skin Therapy Letter. 2013;18(3) 

In This Article


DH is a chronic waxing and waning cutaneous manifestation of CD associated with gluten sensitivity. It presents on extensor surfaces with intensely pruritic papulovesicles, with excoriations and crusting and a corresponding neutrophilic infiltration of dermal papillae and granular IgA deposits on direct immunofluorescence. Serologic test for eTG provides the highest sensitivity and good specificity when compared to tTG and anti-endomysium antibodies, although biopsy is still needed for definitive diagnosis. Generally, DH has a good prognosis with combined initial therapy of GFD and dapsone, usually progressing to dose reduction after a few months. Close monitoring for dapsone toxicities and autoimmune conditions associated with DH is indicated. An inter-professional team involving a dermatologist and dietician, as well as potentially a gastroenterologist and rheumatologist is ideal.