Comment on “Dermatitis herpetiformis in an African woman”: the importance of direct immunofluorescence

Abstract

We read with great interest the recent article by Machona MS et al. [1] about a 30-year-old female with a long history of itch and skin eruption associated to abdominal pain, nausea and vomiting. At clinical examination, she had generalised, symmetrical polymorphic skin lesions located on the trunk, buttocks, extensor surface of the lower limbs and upper limbs. According to skin morphology and histopathology a diagnosis of dermatitis herpetiformis (DH) with suspected celiac disease (CD) was made and the patient underwent a gluten-free diet (GFD) associated to dapsone treatment, with the improvement of the signs and symptoms in the follow-up period. In our opinion, the diagnosis in this case could be consistent with linear IgA bullous dermatosis (LABD) more than DH, and the clinical and histopathological examinations could not be considered criteria sufficient enough to establish adiagnosis of DH. Clinically, the patient presented tense blisters in a pearl necklace-like arrangement on the extremities. These lesions are morphologically consistent with LABD more than DH [2,3]. Moreover, the post-inflammatory hypo and hyper-pigmentated maculae on the abdomen are not typical of DH, whose lesions usually clear without post-inflammatory dyschromia, while they could be seen in LABD (Figure 1).

Keywords

• dermatitis herpetiformis
• linear iga bullous dermatosis
• direct immunofluorescence