A 35-year-old male presents with intensely pruritic grouped vesicles symmetrically distributed over the extensor surfaces of elbows, knees, scalp, and buttocks. He also reports intermittent diarrhoea and bloating. Small bowel biopsy shows subtotal villous atrophy. DIF of uninvolved perilesional skin shows granular IgA deposits in the dermal papillae. What is the drug of choice?

• A Systemic corticosteroids
• B Dapsone with a gluten-free diet ✓
• C Doxycycline plus nicotinamide
• D Mycophenolate mofetil

Explanation

Dermatitis herpetiformis (Duhring's disease) is the cutaneous manifestation of gluten-sensitive enteropathy (coeliac disease). The pathognomonic DIF finding is granular IgA deposits in the tips of dermal papillae (unlike linear IgA disease which shows linear IgA). The target antigen is epidermal transglutaminase (eTG/TG3). Dapsone provides rapid symptomatic relief within 24–48 hours by inhibiting neutrophil chemotaxis. A strict gluten-free diet is the definitive disease-modifying treatment and reduces IgA deposits over years, also lowering the risk of small bowel lymphoma. Both together constitute standard management.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.