Clinical and laboratory features:
(1) pruritic vesicles with an erythematous base that rupture and ulcerate
(2) negative viral cultures for Herpes simplex virus (HSV)
(3) negative assessment for other sexually transmitted diseases (STDs)
(4) serum positive for IgA antibodies against tissue transglutaminase
(5) clinical improvement with dapsone therapy and a gluten-free diet
where:
• A person with dermatitis herpetiformis can have genital herpes. The presence of both disorders can make diagnosis and management more challenging.
• A patient on a gluten-free diet may have a negative test for IgA antibodies to tissue transglutaminase.
Pathologic changes:
(1) A biopsy of an evolving skin lesion may show microabscesses at the tips of the dermal papillae.
(2) A small bowel biopsy may show changes of celiac disease.
Sometimes a patient will first present with recurrent genital lesions and no other skin lesions. Lesions at other sites tend to appear over time.
