A patient with dermatitis herpetiformis adheres strictly to a gluten-free diet and asks when her skin disease will improve. What should she be told?

• A Skin worsens for the first year before any improvement occurs
• B Skin lesions clear within 48 hours, similar to the response seen with dapsone
• C Skin lesions never improve unless dapsone is continued lifelong
• D Improvement of skin lesions takes several months to two years despite rapid gut healing ✓

Explanation

On a strict gluten-free diet the intestinal enteropathy improves within months, but resolution of the skin lesions of dermatitis herpetiformis characteristically takes six months up to two years, so dapsone is usually continued meanwhile. Dapsone suppresses itching and new lesions within 48 to 72 hours by neutrophil inhibition, which is why option B is tempting but wrong: that speed belongs to dapsone, not dietary therapy. Lifelong dapsone is not required once gluten withdrawal takes effect.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.