Snapshot
- A 33-year-old man has a 2 year history of recurrent blistering, and itchy eruptions, especially on his forearms. There are no exacerbating factors. He reports no gastrointestinal symptoms. He has a past medical history of hypothyroidism.
Introduction
- Chronic autoimmune skin disease
- IgA anti-transglutaminase immune complex
- Epidemiology
- males affected more than females (2:1)
- onset in adulthood
- Associated conditions
- other autoimmune conditions such as thyroid disease
Presentation
- Skin findings
- severely itchy and burning blistering eruption
- clustered papules, vesicles, or excoriations
- symmetric distribution, especially on elbows and knees
- oral lesions uncommon
- Other findings
- typically no gastrointestinal symptoms
Evaluation
- Skin biopsy
- gold standard
- subepidermal vesicles with neutrophilic infiltrate
- Small bowel biopsy
- villous atrophy
- Serologic testing
- endomysial antibodies
- tissue transglutaminase antibodies
- epidermal transglutaminase antibodies
Differential Diagnosis
- Scabies (intense unremitting itching)
- Atopic dermatitis
Treatment
- Lifestyle modifications
- gluten-free diet
- Pharmacological
- dapsone
Prognosis, Prevention, and Complications
- Prognosis
- chronic disease
- spontaneous remission in 1/3 of cases
- Prevention
- can be well-controlled with dapsone or gluten-free diet
- Complications
- typically none