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.
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.