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Therapeutic Approach

Dermatitis herpetiformis (DH) is a chronic, cutaneous, blistering disease of the extensor surfaces and scalp that is characterized by severely pruritic, symmetrically distributed papulovesicles. DH is associated with gluten-sensitive enteropathy, with essentially all patients showing evidence of disease activity on gastrointestinal biopsy, even if it is subclinical. DH is diagnosed by skin biopsy showing subepidermal vesiculation and neutrophils in the dermal papillae. Direct immunofluorescence of perilesional skin demonstrates granular deposits of IgA within the dermal papillae. The cornerstones of DH therapy are oral dapsone and/or strict adherence to a gluten-free diet; sulfasalazine is utilized in patients who are unable to tolerate dapsone, and ultra potent topical corticosteroids are first-line antipruritic therapies that are applied as needed during active flares. See Table 45-1.

Table 45-1Dermatitis Herpetiformis Treatment Table

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