A child presents with intensely pruritic grouped papulovesicles on extensor surfaces of elbows, knees, and buttocks. Biopsy shows microabscesses at dermal papillary tips with neutrophils and fibrin. Direct immunofluorescence of perilesional skin shows granular IgA deposits at the dermoepidermal junction. The most appropriate treatment is:

• A Prednisolone 1 mg/kg/day
• B Dapsone plus gluten-free diet ✓
• C Rituximab 1000 mg IV twice
• D Acitretin 0.5 mg/kg/day

Explanation

Dermatitis herpetiformis (DH) presents with intensely pruritic grouped vesicles on extensor surfaces; it is associated with celiac disease. Biopsy shows neutrophilic microabscesses at dermal papillary tips, and DIF shows granular IgA at the DEJ — a pathognomonic finding. Treatment involves dapsone (provides rapid relief within 24-48 hours) combined with a strict gluten-free diet (the only measure that reduces the underlying IgA deposits and may allow dapsone discontinuation). Corticosteroids are ineffective in DH. Rituximab is for pemphigus; acitretin is a retinoid for ichthyosis and psoriasis.

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.