A 50-Year-Old Man with Itchy, Polymorphic Lesions on the Scalp

Abstract

Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease, in which gluten induces skin lesions in genetically susceptible individuals with the human leukocyte antigen (HLA) DQ2 or DQ8 haplotypes. The disease is more common in men compared to women and typically occurs in the fourth decade of life. Dermatitis herpetiformis is characterized by polymorphic skin lesions with the presence of vesicles, papules and macules with coexisting itch. However, because of scratching, only erosions and crusts may be detected. The predilection sites are the elbows, knees and buttocks. Scalp involvement is observed in 30% of patients, but hair loss is rare. 20% of patients with dermatitis herpetiformis exhibit gastrointestinal symptoms at time of initial diagnosis. The diagnosis of dermatitis herpetiformis is based on typical clinical picture and direct immunofluorescence test. Treatment consists of a strict life-long gluten-free diet and sulphonamide drugs (dapsone). Moreover, short term use of potent topical corticosteroids may decrease the itch.