Drug of choice for dermatitis herpetiformis: March 2010, September 2012, March 2013

Ans. C: Dapsone Dermatitis herpetiformis: Epidemiology: Rare, male to female ratio is 2:1, onset at 20 to 40 years of age, but also in children, whites, rare in blacks or Asians Features: Grouped (herpetiform) excoriations or vesicles symmetrically located on extensor remission; watch for signs surfaces of elbows, knees, sacrum, buttocks, and shoulders with intense pruritus and burning sensation Diagnosis: - Light microscopy: neutrophilic abscesses in dermal papillae, dermal infiltrates of neutrophils and eosinophils with subepidermal vesicles. - Direct Immunoflorescence: granular IgA deposits in the tips of the dermal papillae Management: Gluten-free diet; sulfones. Patients will experience prompt relief of lesions within one to two days of initializing treatment with dapsone or sulfapyridine. It is impoant to remember to always check glucose-6-phosphate dehydrogenase (G6PD) and baseline complete blood count levels before staing dapsone, followed by complete blood cell counts every month to monitor for signs of hemolytic anemia. Watch for signs of other autoimmune disorders; may coexist with gluten-sensitive enteropathv