Dermatitis herpetiformis is an intensely pruritic, chronic disease that manifests with small, tense blisters that are distributed sym-metrically over the elbows, knees, buttocks, and nape of the neck. It is most common between the ages of 20 and 40 years but can appear at any age. Most patients with dermatitis herpetiformis have a subclinical defect in gluten metabolism.
Most patients respond to dapsone (combination of tetracycline and nicotinamide) and to a gluten-free diet. All patients should be screened for glucose-6-phosphate dehydrogenase deficiency, because dapsone can induce severe hemolysis in those with this deficiency. Patients benefit from dietary counseling because the dietary restrictions are lifelong, and a gluten-free diet is often dif-ficult to follow. They need emotional support as they deal with the process of learning new habits and accepting major changes in their life.
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