Dermatitis Herpetiformis

Condition

A rare but persistent vesicular/bullous inflammatory condition linked to coeliac disease. Affects young adults.

History and examination

Very itchy, typically affecting the elbows, knees, buttocks, and scalp. Symmetrical distribution; itchy papules and vesicles on normal or reddened skin — the vesicles are rarely seen intact, as they’re scratched open almost immediately.

Management

A gluten-free diet is the cornerstone of treatment. Dapsone 25 mg daily, increased cautiously to a maximum of 100 mg daily if required, can control symptoms while the diet takes effect — monitor for haemolytic anaemia. Manage under expert (dermatology/gastroenterology) care.