Dr. Wendy Levinbook, MD discusses Dermatitis Herpetiformis. See more at www.dermnet.com PLEASE RATE AND COMMENT!!! Dermatitis herpetiformis (DH) may occur at any age but patients typically present in the 2nd to 4th decades of life. It is twice as common in males. Most patients have an associated asymptomatic gluten sensitive enteropathy that may be demonstrated by small bowel biopsy. Clinically, patients present with single or grouped vesicles, papules, or urticarial plaques. Lesions are typically distributed symmetrically on extensor surfaces with involvement of the elbows, knees, buttocks, shoulders, and sacral areas most commonly. Many also have involvement of the scalp, posterior nuchal area, face, and facial hairline. Mucous membranes are typically spared. Patients usually experience severe burning and itching. These symptoms often precede the appearance of skin lesions by 8 to 12 hours. In addition, signs and symptoms such as steatorrhea, abnormal D-xylose absorption, iron or folate deficiency anemia due to malabsorption, achlorhydira, atrophic gastritis, and pernicious anemia as a result of gluten sensitive enteropathy may occur. On electron microscopic exam, blister formation is in the lamina lucida. Histopathologic exam is characterized by collections of neutrophils in the dermal papillae forming microabscesses. Eosinophils and dermal edema leading to subepidermal separation are also typically present. Direct immunofluorescence of normal appearing or perilesional <b>...</b>