Dermatitis Herpetiformis

Key points

• Dermatitis herpetiformis: intensely itchy grouped vesicles on extensor surfaces (elbows, knees, buttocks) — the cutaneous manifestation of coeliac disease.
• Immunofluorescence: granular IgA deposits in the dermal papillae.
• Management: strict gluten-free diet (treats both skin and gut).
• Dapsone gives rapid itch relief (check G6PD first — haemolysis).
• Screen for coeliac disease and associated autoimmune conditions.

Decision points in this pathway

• Severe itch?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.