ABSTRACT

Dermatitis herpetiformis is a distinct clinical entity associated with a gluten-sensitive enteropathy. Both the rash and the enteropathy are gluten-dependent and clear with gluten withdrawal. It is now generally accepted that all patients with dermatitis herpetiformis have associated gluten-sensitive enteropathy although in many patients it is mild. It has been known for nearly 30 years that there is a human leukocyte antigen association with Dermatitis herpetiformis. It is not necessary to take a biopsy from a lesion to establish the diagnosis of Dermatitis herpetiformis. The presence of immunoglobulin A (IgA) in the uninvolved skin is the sine qua non for the diagnosis. The presence of IgA in the upper dermis of uninvolved skin is the criterion for diagnosing Dermatitis herpetiformis. It is important to stress that the biopsy must be taken from uninvolved skin, as the immunoglobulins are destroyed in the actual skin lesions.