dermatits herpetiformis

Question 1

what granular deposits are duagnostix

Answer 1

■ Achronic, recurrent, intensely pruritic eruption occurring symmetrically on the extremities and the trunk.
■ Consists o tiny vesicles, papules, and urticarial plaques that are arranged in groups.
■ Associated with gluten-sensitive enteropathy (GSE).
■ Characterized histologically by papillary collection o neutrophils.
■ Granular IgAdeposits in paralesional or normal skin are diagnostic.
■ Responds to sul a drugs and, to a lesser extent, a gluten- ree diet

Question 2

age

gender

Answer 2

AGEOFONSET Mostcommonat30to40years; may occur in children.

SEX Male: emale ratio is 2:1

Question 3

precipitating factor

Answer 3

Symptomso enprecedetheappearanceo skin lesionsby8to12h.Ingestiono iodidesand overload o gluten are exacerbating actors

Question 4

skin lesions

Answer 4

Erythematouspapulesorwheal- like plaques (Fig. 6-17); tiny rm-topped vesicles, sometimes hemorrhagic

Question 5

predilection

Answer 5

Extensor areas—elbows (Fig. 6-18), knees. Strikingly symmetrical. Buttocks, scapular, and sacral areas (Figs. 6-18 and 6-19). Here, o en in a “butter y” ashion. Scalp, ace, and hairline

Question 6

HLA types assoc to

Answer 6

IMMUNOGENETICS Association with HLA-B8, HLA-DR, and HLA-DQ

Question 7

IF

Answer 7

granular igA Deposits
c3
c5

Question 8

tx

Answer 8

SYSTEMICTHERAPY Dapsone. 100 to 150 mg daily, with gradual reduction to as low as 50 mg twiceaweek.Dramaticresponse,o enwithin hours. Obtain a glucose-6-phosphate dehydro- genase level be ore starting sul ones; obtain methemoglobin levels in the initial 2 weeks and
ollow blood counts care ully.
Sulfapyridine. 1 to 1.5 g/d, with plenty o u- ids, i dapsone contraindicated or not tolerated. Monitor or casts in urine and kidney unction. DIET A gluten- ree diet may suppress the disease or allow reduction in the dosage of dapsone or sul apyridine, but response is very slow.