This 45-year-old woman developed a symmetric,herpetiform, erythematous, papulovesicular eruption associated with intense itching and burning around her elbows that rapidly spread to invove the extensor surfaces of her extremities, buttocks, shoulders and posterior scalp and neck. Before seeking treatment, the eruption disseminated to the flexural sufaces of the extremities and her palms and soles. She also complained of bloating and diarrehea. A skin biopsy showed changes typical of dermatitis herpetiformis. Her skin lesions and gastrointestinal symptoms resolved within 48 hours of initiating therapy with oral dapsone 50 mg twice daily. She was also started a gluten free diet.
symmetric, herpetiform, erythematous papules and vesicles